The nurse is providing discharge teaching for a client with newly diagnosed Crohn's disease about dietary measures to implement during exacerbation episodes. Which statement made by the client indicates a need for further instruction?

1."I need to increase fiber in my diet every day."

2"I will need to avoid caffeinated beverages."

3"I'm going to learn some stress reduction techniques."

4"I can have exacerbations and remissions with Crohn's disease."

1."I need to increase fiber in my diet every day."

The nurse is reviewing the record of a client with a diagnosis of cirrhosis and notes that there is documentation of the presence of asterixis. How would the nurse assess for its presence?

1.Dorsiflex the client's foot.

2.Measure the abdominal girth.

3.Ask the client to extend the arms.

4.Instruct the client to lean forward.

3.Ask the client to extend the arms.

The nurse is reviewing the laboratory results for a client with cirrhosis and notes that the ammonia level is 85 mcg/dL (51 mcmol/L). Which dietary selection does the nurse suggest to the client?

1.Roast pork

2.Cheese omelet

3.Pasta with sauce

4.Tuna fish sandwich

3.Pasta with sauce

The nurse is doing an admission assessment on a client with a history of duodenal ulcer. To determine whether the problem is currently active, the nurse would assess the client for which sign(s)/symptom(s) of duodenal ulcer?

1.Weight loss

2.Nausea and vomiting

3.Pain relieved by food intake

4.Pain radiating down the right arm

3.Pain relieved by food intake

The nurse is providing care for a client with a recent transverse colostomy created to resolve a bowel obstruction. Which observation requires immediate notification of the primary health care provider?

1.Stoma is beefy red and shiny

2.Purple discoloration of the stoma

3.Skin excoriation around the stoma

4.Semi-formed stool noted in the ostomy pouch

2.Purple discoloration of the stoma

A client had a colectomy 2 days earlier to remove a bowel tumor and had a new colostomy created. The client is beginning to pass malodorous flatus from the stoma. What is the correct interpretation by the nurse?

1.This is a normal, expected event.

2.The client is experiencing early signs of ischemic bowel.

3.The client would not have the nasogastric tube removed.

4.This indicates inadequate preoperative bowel preparation.

1.This is a normal, expected event.

A client has just had surgery to create an ileostomy for treatment of a bowel obstruction. The nurse assesses the client in the postoperative period for which most frequent complication of this type of surgery?

1.Folate deficiency

2Malabsorption of fat

3.Intestinal obstruction

4.Fluid and electrolyte imbalance

4.Fluid and electrolyte imbalance

The nurse provides instructions to a client about measures to treat inflammatory bowel syndrome (IBS). Which statement by the client indicates a need for further teaching?

1."I need to limit my intake of dietary protein."

2"I need to drink plenty, at least 8 to 10 cups daily."

3"I need to eat regular meals and chew my food well."

4"I will take the prescribed medications because they will regulate my bowel patterns."

1."I need to limit my intake of dietary protein."

The nurse is monitoring a client for the early signs and symptoms of dumping syndrome. Which findings indicate this occurrence?

1.Sweating and pallor

2.Bradycardia and indigestion

3.Double vision and chest pain

4.Abdominal cramping and pain

1.Sweating and pallor

After undergoing Billroth I gastric surgery, the client experiences fatigue and complains of numbness and tingling in the feet and difficulties with balance. On the basis of these symptoms, the nurse suspects which postoperative complication?

1.Stroke

2.Pernicious anemia

3.Bacterial meningitis

4.Peripheral arterial disease

2.Pernicious anemia

A client experiencing chronic dumping syndrome makes the following comments to the nurse. Which one indicates the need for further teaching?

1."I eat at least 3 large meals each day."

2"I eat while lying in a semirecumbent position."

3."I have eliminated taking liquids with my meals."

4"I eat a high-protein, low- to moderate-carbohydrate diet."

1."I eat at least 3 large meals each day."

The nurse obtains an admission history for a client with suspected peptic ulcer disease (PUD). Which client factor documented by the nurse would increase the risk for PUD?

1.Recently retired from a job

2.Significant other has a gastric ulcer

3.Occasionally drinks 1 cup of coffee in the morning

4.Takes nonsteroidal anti-inflammatory drugs (NSAIDs) for osteoarthritis

4.Takes nonsteroidal anti-inflammatory drugs (NSAIDs) for osteoarthritis

A client who has undergone gastric surgery to remove a tumor has a nasogastric (NG) tube connected to low intermittent suction that is not draining properly. Which action would the nurse take initially?

1.Call the surgeon to report the problem.

2.Reposition the NG tube to the proper location.

3.Check the suction device to make sure it is working.

4.Irrigate the NG tube with saline to remove the obstruction.

3.Check the suction device to make sure it is working.

The nurse is caring for a client with ulcerative colitis. Which finding does the nurse determine is consistent with this diagnosis?

1.Hypercalcemia

2Hypernatremia

3.Frothy, fatty stools

4.Decreased hemoglobin

4.Decreased hemoglobin

A client with acute ulcerative colitis requests a snack. Which is the most appropriate snack for this client?

1.Carrots and ranch dip

2.Whole-grain cereal and milk

3.A cup of popcorn and a cola drink

4.Gelatin and a graham cracker

4.Gelatin and a graham cracker

The nurse is teaching the client with viral hepatitis about the stages of the disease. The nurse would explain to the client that the second stage of this disease is characterized by which specific assessment findings? Select all that apply.

1.Jaundice

2.Flu-like symptoms

3.Clay-colored stools

4.Elevated bilirubin levels

5.Dark or tea-colored urine

1.Jaundice

3.Clay-colored stools

4.Elevated bilirubin levels

5.Dark or tea-colored urine

The nurse is teaching a client with hemorrhoids about measures to prevent constipation. Which statement by the client indicates a need for further teaching?

1."I walk 1 to 2 miles every day."

2."I need to decrease fiber in my diet."

3."I have a bowel movement every other day.

"4."I drink 6 to 8 glasses of water every day."

2."I need to decrease fiber in my diet."

The nurse is giving instructions to a client with cholecystitis about food to exclude from the diet. Which food item identified by the client indicates that the educational session was successful?

1.Fresh fruit

2.Brown gravy

3.Fresh vegetables

4.Poultry without skin

2.Brown gravy

The nurse is performing an assessment on a client with acute pancreatitis who was admitted to the hospital. Which assessment question would most specifically elicit information regarding the pain that is associated with acute pancreatitis?

1."Does the pain in your stomach radiate to your back?"

2"Does the pain in your lower abdomen radiate to your hip?"

3"Does the pain in your lower abdomen radiate to your groin?"

4"Does the pain in your stomach radiate to your lower middle abdomen?"

1."Does the pain in your stomach radiate to your back?"

The nurse is caring for a client after abdominal surgery to treat a malignant bowel tumor with creation of a colostomy. The nurse is assessing the client for a prolapsed stoma and would expect to note which observation if this is present?

1.A sunken and hidden stoma

2.A narrow and flattened stoma

3.A stoma that is dusky or bluish

4.A stoma that is elongated with a swollen appearance

4.A stoma that is elongated with a swollen appearance

The nurse is providing instructions to a client with a colostomy about measures to reduce the odor from the colostomy. Which client statement indicates that the educational session was effective?

1."I need to be sure to eat at least 1 cucumber every day."

2"I will need to increase my egg intake and try to eat ½ to 1 egg per day."

3"Beet greens, parsley, or yogurt will help to control the colostomy odor."

4"Green vegetables such as spinach and broccoli will prevent odor, and I should eat these foods every day."

3"Beet greens, parsley, or yogurt will help to control the colostomy odor."

The nurse has provided dietary instructions to a client with a diagnosis of peptic ulcer disease. Which client statement indicates that education was effective?

1."Baked foods such as chicken or fish are all right to eat."

2"Citrus fruits and raw vegetables need to be included in my daily diet."

3"I can drink beer as long as I consume only a moderate amount each day."

4"I can drink coffee or tea as long as I limit the amount to 2 cups daily."

1."Baked foods such as chicken or fish are all right to eat."

The nurse has provided home care instructions to a client who had a subtotal gastrectomy. The nurse instructs the client on the signs and symptoms associated with dumping syndrome. Which client statement indicates that teaching was effective?

1."It will cause diaphoresis and diarrhea."

2"I have to monitor for hiccups and diarrhea."

3"It will be associated with constipation and fever."

4"I have to monitor for fatigue and abdominal pain."

1."It will cause diaphoresis and diarrhea."

The nurse is providing instructions to a client regarding measures to minimize the risk of dumping syndrome. The nurse would make which suggestion to the client?

1.Eat foods low in complex carbohydrates.

2.Increase fluid intake, particularly at mealtime.

3.Maintain a low-Fowler's position after eating.

4Ambulate for at least 30 minutes following each meal.

3.Maintain a low-Fowler's position after eating.

A client with peptic ulcer disease states that stress frequently causes exacerbation of the disease. The nurse determines that which item mentioned by the client is most likely to be responsible for the exacerbation?

1.Sleeping 8 to 10 hours a night

2.Ability to work at home periodically

3.Eating 5 or 6 small meals per day

4.Frequent need to work overtime on short notice

4.Frequent need to work overtime on short notice

The nurse is giving dietary instructions to a client who has a new colostomy created to treat a bowel obstruction. The nurse would encourage the client to eat foods representing which diet for the first few weeks postoperatively?

1.Low fiber

2.Low calorie

3.High protein

4.High carbohydrate

1.Low fiber

A client with viral hepatitis is discussing with the nurse the need to avoid alcohol and states, "I'm not sure I can avoid alcohol." What is the most appropriate nursing response?

1."I don't believe that."

2"Everything will be all right."

3"I'm not sure that I understand. Would you please explain?"

4"I think you need to talk more with the primary health care provider about this.

3"I'm not sure that I understand. Would you please explain?"

A client with viral hepatitis has no appetite, and food makes the client nauseated. Which nursing intervention is appropriate?

1.Encourage foods that are high in protein.

2.Monitor for fluid and electrolyte imbalance.

3.Explain that high-fat diets usually are better tolerated.

4.Explain that most daily calories need to be consumed in the evening hours.

2.Monitor for fluid and electrolyte imbalance.

The nurse has implemented a bowel maintenance program for an unconscious client. The nurse would evaluate the plan as best meeting the needs of the client if which method was successful in stimulating a bowel movement?

1.Fleet enema

2.Fecal disimpaction

3.Glycerin suppository

4.Soap solution enema (SSE)

3.Glycerin suppository

The nurse is developing a teaching plan for a client with viral hepatitis. The nurse would plan to include which information in the teaching session?

1.The diet needs to be low in calories.

2.Meals need to be large to conserve energy.

3Activity would be limited to prevent fatigue.

4Alcohol intake needs to be limited to 2 ounces per day.

3.Activity would be limited to prevent fatigue.

The nurse is preparing to teach a client with a new colostomy about how to perform a colostomy irrigation. Which information would the nurse include in the teaching plan?

1.Use 500 to 1000 mL of warm tap water.

2.Suspend the irrigant 36 inches above the stoma.

3.Insert the irrigation cone ½ inch into the stoma.

4.If cramping occurs, open the irrigation clamp farther.

1.Use 500 to 1000 mL of warm tap water.

The nurse is assigned to care for a client with a Sengstaken-Blakemore tube for the treatment of esophageal varices. Which laboratory result is most focused on evaluating the effectiveness of this tube?

1.Sodium

2.Creatinine

3.Ammonia

4.Hemoglobin

4.Hemoglobin

The nurse has been caring for a client who required a Sengstaken-Blakemore tube because other treatment measures for esophageal varices were unsuccessful. The primary health care provider (PHCP) arrives on the nursing unit and deflates the esophageal balloon. Which assessment finding by the nurse is the most important and would be reported to the PHCP immediately?

1.Hematemesis

2.Bloody diarrhea

3.Swelling of the abdomen

4.An elevated temperature and a rise in blood pressure

1.Hematemesis

A client in a long-term care facility is being prepared to be discharged to home in 2 days. The client has been eating a regular diet for a week; however, the client is still receiving intermittent enteral tube feedings and will need to receive these feedings at home. The client states concern about not being able to continue the tube feedings at home. Which nursing response is most appropriate at this time?

1."Do you want to stay here in this facility for a few more days?"

2"Tell me more about your concerns with your diet after going home."

3"Have you discussed your feelings with your primary health care provider?"

4"You need to talk to your primary health care provider about these concerns."

2"Tell me more about your concerns with your diet after going home."

The nurse is performing an assessment on a client with suspected acute pancreatitis. Which complaint made by the client supports the diagnosis?

"I have epigastric pain radiating to my neck."

2"I have severe abdominal pain that is relieved after vomiting."

3"My temperature has been running between 96° F (35.5° C) and 97° F (36.1° C)."

4."I've been experiencing constant, severe abdominal pain that is unrelieved by vomiting."

4."I've been experiencing constant, severe abdominal pain that is unrelieved by vomiting."

The nurse who is caring for a client with a diagnosis of cirrhosis is monitoring the client for signs of portal hypertension. Which finding would the nurse interpret as a sign or symptom of portal hypertension?

1.Flat neck veins

2.Abdominal distention

3.Hemoglobin of 14.2 g/dL (142 mmol/L)

4.Platelet count of 600,000 mm³ (600 × 10⁹/L)

2.Abdominal distention

The nurse is creating a plan of care for a client with cirrhosis and ascites. Which nursing actions would be included in the care plan for this client? Select all that apply.

1.Monitor daily weight.

2.Measure abdominal girth.

3.Monitor respiratory status.

4.Place the client in a supine position.

5.Assist the client with care as needed.

1.Monitor daily weight.

2.Measure abdominal girth.

3.Monitor respiratory status.

5.Assist the client with care as needed.

The nurse is monitoring a client with cirrhosis of the liver for signs of hepatic encephalopathy. Which assessment finding would the nurse note as an early sign of hepatic encephalopathy?

1.Fatigue on exertion

2.Presence of asterixis

3.Elevated pulse rate

4.Decreased serum ammonia levels

2.Presence of asterixis

The nurse would anticipate that the primary health care provider (PHCP) will prescribe which treatment for a client with pernicious anemia?

1.Oral iron tablets

2.Blood transfusions

3.Gastric tube feedings

4.Vitamin B₁₂ injections

4.Vitamin B₁₂ injections

A client arrives at the hospital emergency department complaining of acute right lower quadrant abdominal pain, and appendicitis is suspected. Laboratory tests are performed, and the nurse notes that the client's white blood cell (WBC) count is elevated. On the basis of these findings, the nurse would question which primary health care provider (PHCP) prescription documented in the client's medical record?

1.Apply a cold pack to the abdomen.

2.Maintain nothing by mouth (NPO) status.

3.Administer 30 mL of milk of magnesia (MOM).

4.Initiate an intravenous (IV) line for the administration of IV fluids.

3.Administer 30 mL of milk of magnesia (MOM).

The nurse is caring for a client with a small bowel obstruction who is prescribed a nasogastric (NG) tube for the purpose of stomach decompression. The nurse would anticipate a primary health care provider prescription for which type of suction?

1.Low and continuous

2.High and continuous

3.High and intermittent

4.Low and intermittent

4.Low and intermittent

The nurse is providing dietary instructions to a client with a diagnosis of irritable bowel syndrome. The nurse determines that education was effective if the client states the need to avoid which food?

1.Rice

2Corn

3.Broiled chicken

4.Cream of wheat

2.Corn

Diphenoxylate hydrochloride with atropine sulfate is prescribed for a client with ulcerative colitis. The nurse would monitor the client for which therapeutic effect of this medication?

1.Decreased diarrhea

2Decreased cramping

3.Improved intestinal tone

4Elimination of peristalsis

1.Decreased diarrhea

Sulfasalazine is prescribed for a client with a diagnosis of ulcerative colitis, and the nurse instructs the client about the medication. Which statement made by the client indicates a need for further teaching?

1."The medication will cause constipation."

2"I need to take the medication with meals."

3"I may be more sensitive to sunlight than usual."

4"This medication needs to be taken as prescribed."

1."The medication will cause constipation."

A client with cirrhosis has ascites and excess fluid volume. Which assessment findings does the nurse anticipate to note as a result of increased abdominal pressure? Select all that apply.

1.Orthopnea and dyspnea

2Petechiae and ecchymosis

3.Inguinal or umbilical hernia

4.Poor body posture and balance

5.Abdominal distention and tenderness

1.Orthopnea and dyspnea

2Petechiae and ecchymosis

3.Inguinal or umbilical hernia

5.Abdominal distention and tenderness

A client has been advanced to a solid diet after undergoing a subtotal gastrectomy. What is the appropriate nursing intervention in preventing dumping syndrome?

1.Remove fluids from the meal tray.

2.Give the client 2 large meals per day.

3.Ask the client to sit up for 1 hour after eating.

4.Provide a diet high in simple carbohydrate foods.

1.Remove fluids from the meal tray.

The nurse is caring for a client with gastroesophageal reflux disease (GERD) and provides client education on measures to decrease GERD. Which statement made by the client indicates a need for further teaching?

1."I plan to eat four to six small meals a day."

2."I need to sleep in the right side-lying position."

3."I plan to have a snack 1 hour before going to bed."

4."I will stop having a glass of wine each evening with dinner."

3."I plan to have a snack 1 hour before going to bed."

The nurse is completing an admission assessment for a client with suspected esophageal cancer. Which statement made by the client indicates the presence of a risk factor for esophageal cancer?

1."I've been smoking for 20 years now."

2"I eat plenty of fresh fruits and vegetables."

3"I'm 5 feet, 8 inches tall and weigh 160 pounds."

4"My alcohol consumption is about 2 beers per month."

1."I've been smoking for 20 years now."

The registered nurse is precepting a new nurse who is caring for a client with pernicious anemia as a result of a gastrectomy. Which statement made by the new nurse indicates understanding of this diagnosis?

1."It's due to insufficient production of vitamin B12 in the colon."

2."Increased production of intrinsic factor in the stomach leads to this type of anemia."

3."Overproduction of vitamin B12 in the large intestine can result in pernicious anemia."

4."Decreased production of intrinsic factor by the stomach affects absorption of vitamin B12 in the small intestine."

4."Decreased production of intrinsic factor by the stomach affects absorption of vitamin B12 in the small intestine."

A client with a diagnosis of stomach ulcer from gastric hyperacidity asks the nurse why the acid has not caused an ulcer in the small intestine as well. The nurse responds that the pH of intestinal contents is raised by bicarbonate, which is present in which area of the body?

1.Bile

2.Parietal cells

3.Liver enzymes

4.Pancreatic juice

4.Pancreatic juice

A client with appendicitis is scheduled for an appendectomy. The nurse providing preoperative teaching for the client describes the location of the appendix by stating that it is attached to which part of the gastrointestinal (GI) system?

1.Ileum

2.Cecum

3.Rectum

4.Jejunum

2.Cecum

The nurse is caring for a hospitalized client with pancreatitis. Which findings would the nurse look for and expect to note when reviewing the laboratory results? Select all that apply.

1.Elevated lipase level

2.Elevated lactase level

3.Elevated trypsin level

4.Elevated amylase level

5.Elevated sucrase level

1.Elevated lipase level

3.Elevated trypsin level

4.Elevated amylase level

The nurse is caring for a group of clients on the surgical nursing unit. The nurse anticipates that the client who underwent which procedure is most likely to have some long-term residual difficulty with absorption of nutrients?

1.Colectomy

2.Appendectomy

3.Ascending colostomy

4.Small bowel resection

4.Small bowel resection

The nurse is caring for a client with common bile duct obstruction. The nurse would anticipate that the primary health care provider (PHCP) will prescribe which diet for this client?

1.Low fat

2.High protein

3.High carbohydrate

4.Low in water-soluble vitamins

1.Low fat

hospitalized client with liver disease has a dietary protein restriction. The nurse encourages intake of which source of complete proteins to maximize the availability of essential amino acids?

1.Nuts

2.Meats

3.Cereals

4.Vegetables

2.Meats

The nurse is assessing a client with cirrhosis for signs and symptoms of low albumin. Which sign or symptom would the nurse expect to note?

1.Weight loss

2.Peripheral edema

3.Capillary refill of 5 seconds

4.Bleeding from previous puncture sites

2.Peripheral edema

The nurse is caring for a client with altered protein metabolism as a result of liver dysfunction. Which finding would the nurse expect to note when reviewing the client's laboratory results?

1.Increased lactase level

2.Decreased albumin level

3.Increased ammonia level

4.Decreased lactic acid level

3.Increased ammonia level

The nurse is caring for a client admitted with severe weight loss due to dieting. Based on the data provided, the nurse plans care knowing that which condition is likely occurring in this client?

1.Lactic acidosis

2.Glycogenolysis

3.Gluconeogenesis

4.Glucose metabolism

3.Gluconeogenesis

The nurse is caring for a client with gallbladder disease who is experiencing nutrition problems due to biliary obstruction. The nurse understands that obstruction of which passage is related to the client's condition?

1.Cystic duct

2Liver canaliculi

3.Common bile duct

4.Right hepatic duct

1.Cystic duct

The nurse is caring for a client with a low thrombin level as a result of cirrhosis. Based on this finding it is most important for the nurse to monitor the client for signs and symptoms of which potential complication?

1.Bleeding

2.Infection

3.Dehydration

4.Malnutrition

1.Bleeding

The nurse is caring for an older client. The nurse would anticipate that medication dosages will be further adjusted if the client has dysfunction of which organ?

1.Liver

2.Stomach

3.Pancreas

4.Gallbladder

1.Liver

The nurse is caring for a client with pancreatitis. Which finding would the nurse expect to note when reviewing the client's laboratory results?

1.Elevated level of pepsin

2.Decreased level of lactase

3.Elevated level of amylase

4.Decreased level of enterokinase

3.Elevated level of amylase

A client with gastritis experiencing chronic gastric hypersecretion is scheduled for surgery. The nurse teaches the client that the procedure will lessen the stomach's production of acid by altering which structure?

1.Portal vein

2.Celiac artery

3.Vagus nerve

4.Pyloric valve

3.Vagus nerve

Lactulose is prescribed for a hospitalized client with a diagnosis of hepatic encephalopathy. Which assessment finding indicates that the client is responding to this medication therapy as anticipated?

1.Vomiting occurs.

2.The fecal pH is acidic.

3The client experiences diarrhea.

4The client is able to tolerate a full diet.

2.The fecal pH is acidic.

Cholestyramine resin is prescribed for a client with an elevated serum cholesterol level. The nurse would instruct the client to take the medication in which way?

1.After meals

2.Mixed with fruit juice

3.Via a rectal suppository

4.At least 3 hours before meals

2.Mixed with fruit juice

The nurse is evaluating the plan of care for a client with peptic ulcer disease (PUD) who is experiencing acute pain. The nurse determines that the expected outcomes have been met if the nursing assessment reveals which result?

1.The client reports some pain before meals.

2.The client frequently is awakened at 2 a.m. with heartburn.

3.The client has eliminated any irritating foods from the diet.

4.The client's pain is minimal with histamine H2-receptor antagonists.

3.The client has eliminated any irritating foods from the diet.

A client is readmitted to the hospital with dehydration after surgery for creation of an ileostomy. The nurse assesses that the client has lost 3 lb of weight, has poor skin turgor, and has concentrated urine. The nurse interprets the client's clinical picture as correlating most closely with recent intake of which medication, which is contraindicated for the ileostomy client?

1.Folate

2.Biscodyl

3.Ferrous sulfate

4.Cyanocobalamin

2.Biscodyl

A Penrose drain is in place on the first postoperative day in a client who has undergone a cholecystectomy procedure. Serosanguineous drainage is noted on the dressing covering the drain. Which nursing intervention is most appropriate?

1.Change the dressing.

2.Continue to monitor the drainage.

3.Notify the primary health care provider (PHCP).

4.Use a pen to circle the amount of drainage on the dressing.

1.Change the dressing.

A home care nurse is visiting a client with a diagnosis of pernicious anemia that developed as a result of gastric surgery. The nurse instructs the client that in this disorder, because the stomach lining produces a decreased amount of a substance known as the intrinsic factor, the client will need which medication?

1.An antacid

2.An antibiotic

3.Vitamin B6 injections

4.Vitamin B12 injections

4.Vitamin B12 injections

A client arrives at the hospital emergency department complaining of acute right lower quadrant abdominal pain. Appendicitis is suspected, and appropriate laboratory tests are performed. The emergency department nurse reviews the test results and notes that the client's white blood cell (WBC) count is elevated. The nurse also reviews the prescriptions from the primary health care provider (PHCP). The nurse would contact the PHCP to question which order if noted in the client's record?

1.Maintain a semi-Fowler's position.

2.Maintain on NPO (nothing by mouth) status.

3.Apply a heating pad to the lower abdomen for comfort.

4.Initiate an intravenous (IV) line with the administration of IV fluids.

3.Apply a heating pad to the lower abdomen for comfort.

The nurse is caring for a client prescribed enteral feeding via a newly inserted nasogastric (NG) tube. Before initiating the enteral feeding, the nurse would perform which action first?

1.Warm the feeding to 103° F (39.4° C).

2.Confirm NG placement by x-ray study.

3.Make sure the continuous enteral feeding tubing is primed.

4.Position the head of the client's bed to 30 degrees or greater.

2.Confirm NG placement by x-ray study.

The nurse has given instructions to a client with hepatitis about postdischarge management during convalescence. The nurse determines that further teaching is needed if the client makes which statement?

1."I need to avoid alcohol and aspirin."

2"I would eat a high-carbohydrate, low-fat diet."

3"I can resume a full activity level within 1 week."

4"I need to take the prescribed amounts of vitamin K."

3."I can resume a full activity level within 1 week."

The nurse is caring for a client who had a subtotal gastrectomy. The nurse would assess the client for which signs and symptoms of dumping syndrome?

1.Diarrhea, chills, and hiccups

2.Weakness, diaphoresis, and diarrhea

3.Fever, constipation, and rectal bleeding

4.Abdominal pain, elevated temperature, and weakness

2.Weakness, diaphoresis, and diarrhea

The nurse is caring for a client who has just returned from the operating room after colectomy to remove a bowel tumor and the creation of a colostomy. The nurse is assessing the drainage in the pouch attached to the site where the colostomy was formed and notes serosanguineous drainage. Which nursing action is appropriate based on this assessment?

1.Apply ice to the stoma site.

2.Apply pressure to the stoma site.

3Notify the primary health care provider (PHCP).

4.Document the amount and characteristics of the drainage.

4.Document the amount and characteristics of the drainage.

A client has a large, deep duodenal ulcer diagnosed by endoscopy. Which sign or symptom indicative of a complication would the nurse look for during the client's postprocedure assessment?

1.Bradycardia

2.Nausea and vomiting

3.Numbness in the legs

4.A rigid, boardlike abdomen

4.A rigid, boardlike abdomen

The nurse is assisting a client with Crohn's disease to ambulate to the bathroom. After the client has a bowel movement, the nurse would assess the stool for which characteristic that is expected with this disease?

1.Blood in the stool

2.Chalky gray stool

3.Loose, watery stool

4.Dark brown pellet-like stools

3.Loose, watery stool

The nurse is reviewing the results of serum laboratory studies for a client admitted for suspected hepatitis. Which laboratory finding is most associated with hepatitis, requiring the nurse to contact the primary health care provider?

1.Elevated serum bilirubin level

2.Below-normal hemoglobin concentration

3.Elevated blood urea nitrogen (BUN) level

4.Elevated erythrocyte sedimentation rate (ESR)

1.Elevated serum bilirubin level

The nurse is assessing a client with a duodenal ulcer. The nurse interprets that which sign or symptom is most consistent with the typical presentation of duodenal ulcer?

1.Weight loss

2.Nausea and vomiting

3.Pain that is relieved by food intake

4.Pain that radiates down the right arm

3.Pain that is relieved by food intake

The nurse is assisting a physician with the insertion of a Miller-Abbott tube. The nurse understands that the procedure places the client at risk for aspiration and would therefore plan which action to decrease this risk?

1.Insert the tube with the balloon inflated.

2.Place the client in a semi-Fowler's to high-Fowler's position.

3.Instruct the client to cough when the tube reaches the nasal pharynx.

4.Instruct the client to perform a Valsalva maneuver if the impulse to gag and vomit occurs.

2.Place the client in a semi-Fowler's to high-Fowler's position.

The nurse is obtaining a health history for a client with chronic pancreatitis. The health history is most likely to include which as a most common causative factor in this client's disorder?

1.Weight gain

2Use of alcohol

3.Exposure to occupational chemicals

4.Abdominal pain relieved with food or antacids

2Use of alcohol

A client seen in the ambulatory care clinic has ascites and slight jaundice. The nurse would assess the client for a history of chronic use of which medication?

1.Ibuprofen

2.Ranitidine

3.Acetaminophen

4.Acetylsalicylic acid

3.Acetaminophen

The nurse teaches a preoperative client about the use of a nasogastric (NG) tube for the planned surgery. Which statement indicates to the nurse that the client understands when the tube can be removed in the postoperative period?

1."When I can tolerate food without vomiting."

2"When my gastrointestinal system is healed enough."

3"When my bowels begin to function again, and I begin to pass gas."

4"When my primary health care provider says the tube can come out."

3"When my bowels begin to function again, and I begin to pass gas."

A client with gastritis asks the nurse at a screening clinic about analgesics that will not cause epigastric distress. The nurse would tell the client that which medication is acceptable to take?

1.Ibuprofen

2.Indomethacin

3.Acetaminophen

4.Naproxen sodium

3.Acetaminophen

The nurse is providing dietary instructions to a client hospitalized for pancreatitis. Which food would the nurse instruct the client to avoid?

1.Bagel

2.Watermelon

3.Lentil soup

4.Salsa and corn chips

4.Salsa and corn chips

A home care nurse visits a client who was recently diagnosed with cirrhosis. The nurse provides home care management instructions to the client. Which client statement indicates a need for further instruction?

1."I will obtain adequate rest."

2"I will take acetaminophen if I get a headache."

3"I need to monitor my weight on a regular basis."

4"I need to include sufficient amounts of carbohydrates in my diet."

2."I will take acetaminophen if I get a headache."

A client with acute pancreatitis is experiencing severe pain from the disorder. The nurse determines that education about positioning to reduce pain was effective if the client avoids which action?

1.Sitting up

2.Lying flat

3.Leaning forward

4.Drawing the legs to the chest

2.Lying flat

The nurse is caring for a client who is receiving bolus feedings via a nasogastric tube. As the nurse is finishing the feeding, the client asks for the bed to be positioned flat for sleep. The nurse plans to assist the client to which appropriate position at this time?

1.Head of bed flat, with the client supine for 60 minutes

2.Head of bed flat, with the client in the supine position for at least 30 minutes

3.Head of bed elevated 30 to 45 degrees, with the client in the right lateral position for 60 minutes

4.Head of bed in a semi-Fowler's position, with the client in the left lateral position for 60 minutes

3.Head of bed elevated 30 to 45 degrees, with the client in the right lateral position for 60 minutes

The nurse is preparing to administer an intermittent enteral feeding through a nasogastric (NG) tube. Which priority assessment would the nurse perform?

1.Observe for digestion of formula.

2.Assess fluid and electrolyte status.

3.Evaluate absorption of the last feeding.

4.Evaluate percussion tone of the stomach.

3.Evaluate absorption of the last feeding.

The nurse has inserted a nasogastric (NG) tube to the level of the oropharynx and has repositioned the client's head in a flexed-forward position. The client has been asked to begin swallowing. The nurse starts to slowly advance the NG tube with each swallow. The client begins to cough, gag, and choke. Which actions would the nurse take that will result in proper tube insertion and promote client relaxation? Select all that apply.

1.Pull the tube back slightly.

2.Instruct the client to breathe slowly.

3.Assist the client to take sips of water.

4.Continue to slowly advance the tube to the desired distance.

5.Check the back of the pharynx using a tongue blade and flashlight.

1.Pull the tube back slightly.

2.Instruct the client to breathe slowly.

3.Assist the client to take sips of water.

5.Check the back of the pharynx using a tongue blade and flashlight.

The nurse is caring for a client with acute pancreatitis and is monitoring the client for paralytic ileus. Which assessment data would alert the nurse to this occurrence?

1.Inability to pass flatus

2.Loss of anal sphincter control

3.Severe, constant pain with rapid onset

4.Firm, nontender mass palpable at the lower right costal margin

1.Inability to pass flatus

The client with a small bowel obstruction asks the nurse to explain the purpose of the nasogastric tube attached to continuous gastric suction. The nurse determines that teaching has been effective if the client makes which statement?

1."It will help to provide me with nourishment."

2"It will help to relieve the congestion from excess mucus."

3"It is used to remove gastric contents for laboratory testing.

4"It will help to remove gas and fluids from my stomach and intestine."

4."It will help to remove gas and fluids from my stomach and intestine."

A client is scheduled for an upper gastrointestinal (GI) endoscopy. Which assessment is essential to include in the plan of care following the procedure?

1.Assessing pulses

2.Monitoring urine output

3.Monitoring for rectal bleeding

4.Assessing for the presence of the gag reflex

4.Assessing for the presence of the gag reflex

A client with a gastric ulcer is prescribed both magnesium hydroxide and cimetidine twice daily. How would the nurse schedule the medications for administration?

1.Drink 8 ounces of water between taking each medication.

2.Administer the cimetidine and magnesium hydroxide at the same time twice daily.

3.Administer each dose of cimetidine 1 hour prior to the administration of magnesium hydroxide.

4Collaborate with the primary health care provider (PHCP), as the client should not be receiving both medications.

3.Administer each dose of cimetidine 1 hour prior to the administration of magnesium hydroxide.

The nurse is caring for a client admitted to the hospital with suspected acute appendicitis. Which laboratory result would the nurse expect to note if the client does have appendicitis?

1.White blood cell (WBC) count of 4000 mm3 (4 × 109/L)

2.WBC count of 8000 mm3 (8 × 109/L)

3.WBC count of 18,000 mm3 (18 × 109/L)

4.WBC count of 26,000 mm3 (26 × 109/L)

3.WBC count of 18,000 mm3 (18 × 109/L)

The nurse is caring for a client with acute pancreatitis. Which medications would the nurse expect to be prescribed for treatment of this problem? Select all that apply.

1.Insulin

2Morphine

3.Dicyclomine

4.Pancrelipase

5.Pantoprazole

6.Acetazolamide

2.Morphine

3.Dicyclomine

5.Pantoprazole

6.Acetazolamide

A client is admitted to the hospital with acute viral hepatitis. Which sign or symptom would the nurse expect to note based on this diagnosis?

1.Fatigue

2.Pale urine

3.Weight gain

4.Spider angiomasSubmit

1.Fatigue

The nurse manager is providing an educational session to nursing staff members about the phases of viral hepatitis. The nurse manager tells the staff that which clinical manifestation(s) are primary characteristics of the preicteric phase?

1.Pruritus

2.Right upper quadrant pain

3.Fatigue, anorexia, and nausea

4.Jaundice, dark-colored urine, and clay-colored stools

3.Fatigue, anorexia, and nausea

A client who has a gastrostomy tube for feeding refuses to participate in the plan of care, will not make eye contact, and does not speak to the family or visitors. The nurse interprets that the client is using which coping mechanism?

1.Distancing

2.Self-control

3.Problem solving

4.Accepting responsibility

1.Distancing

The nurse is teaching the postgastrectomy client about measures to prevent dumping syndrome. Which statement by the client indicates a need for further teaching?

1."I need to lie down after eating."

2"I need to drink liquids with meals."

3"I need to avoid concentrated sweets."

4"I need to eat small meals 6 times daily."

2"I need to drink liquids with meals."

The nurse is caring for a client with pernicious anemia. Which prescription by the primary health care provider would the nurse anticipate?

1.Iron

2.Folic acid

3.Vitamin B6

4.Vitamin B12

4.Vitamin B12

A client presents to the emergency department with upper gastrointestinal (GI) bleeding from a gastric ulcer and is in moderate distress. In planning care, which nursing action would be the priority for this client?

1.Assessment of vital signs

2.Complete abdominal examination

3.Thorough investigation of precipitating events

4.Insertion of a nasogastric tube and Hematest of emesis

1.Assessment of vital signs

The nurse is reviewing the primary health care provider's prescriptions written for a client admitted to the hospital with acute pancreatitis. Which prescription requires follow-up by the nurse?

1.Full liquid diet

2Morphine sulfate for pain

3.Nasogastric tube insertion

4.An anticholinergic medication

1.Full liquid diet

The nurse has given postprocedure instructions to a client who has undergone a colonoscopy. Which statement by the client indicates the need for further teaching?

1."It is normal to feel gassy or bloated after the procedure."

2"My abdominal muscles may be tender from the procedure."

3"It is all right to drive once I've been home for an hour or so."

4"Intake needs to be light at first and then progress to regular intake."

3"It is all right to drive once I've been home for an hour or so."

The nurse is reviewing the medication record of a client with acute gastritis. Which medication, if noted on the client's record, would the nurse question?

1.Digoxin

2.Furosemide

3.Indomethacin

4.Propranolol hydrochloride

3.Indomethacin

The nurse is caring for a client postoperatively after creation of a colostomy to treat a bowel tumor. What is an appropriate potential client problem?

1.Fear

2.Sexual dysfunction

3.Altered body image

4.Excessive nutritional intake

3.Altered body image

The nurse is caring for a hospitalized client with a diagnosis of ulcerative colitis. Which finding, if noted on assessment of the client, would the nurse report to the primary health care provider (PHCP)?

1.Hypotension

2.Bloody diarrhea

3.Rebound tenderness

4.A hemoglobin level of 12 mg/dL (120 mmol/L)

3.Rebound tenderness

The medication history of a client with peptic ulcer disease reveals intermittent use of several medications. The nurse would teach the client that which of these medications is not a part of the treatment plan because of its irritating effect on the lining of the gastrointestinal tract?

1.Nizatidine

2.Sucralfate

3.Ibuprofen

4.Omeprazole

3.Ibuprofen

The nurse would instruct a client with an ileostomy to include which action as part of essential care of the stoma?

1.Massage the area below the stoma

2Take in high-fiber foods such as nuts.

3.Limit fluid intake to prevent diarrhea.

4.Cleanse the peristomal skin meticulously.

4.Cleanse the peristomal skin meticulously.

client who has undergone creation of a colostomy has a concern about body image. What action by the client indicates the most significant progress toward identified goals?

1.Looking at the ostomy site

2.Reading the ostomy product literature

3.Watching the nurse empty the ostomy bag

4.Practicing proper cutting of the ostomy appliance

4.Practicing proper cutting of the ostomy appliance

client with a new ileostomy is concerned about the odor from stool in the ostomy drainage bag. The nurse would teach the client to include which food in the diet to reduce odor?

1.Eggs

2Yogurt

3.Broccoli

4Asparagus

2.Yogurt

A client with chronic pancreatitis needs information on dietary modification to manage the health problem. Which item in the diet would the nurse teach the client to limit?

1.Fat

2.Protein

3.Carbohydrate

4.Water-soluble vitamins

1.Fat

The nurse has taught the client with chronic pancreatitis about risk factor modification to reduce the incidence of recurrences. The nurse determines that teaching was effective if the client states that it will be necessary to control which factor?

1.Ulcer

2.Alcohol intake

3.Crohn's disease

4.Diabetes mellitus

2.Alcohol intake

A client with cirrhosis is beginning to show signs of hepatic encephalopathy. The nurse would plan a dietary consultation to limit the amount of which ingredient in the client's diet?

1.Protein

2.Calories

3.Minerals

4.Carbohydrates

1.Protein

A client with cirrhosis complicated by ascites is admitted to the hospital. The client reports a 10-lb weight gain over the past 1½ weeks. The client has edema of the feet and ankles, and the abdomen is distended, taut, and shiny with striae. Which client problem is most appropriate at this time?

1.Difficulty with sleeping

2,Risk for skin breakdown

3.Difficulty with breathing

4.Excessive body fluid volume

4.Excessive body fluid volume

A client with Crohn's disease is experiencing acute pain, and the nurse provides information about measures to alleviate the pain. Which statement by the client indicates the need for further teaching?

1."I know I can massage my abdomen."

2"I will continue using antispasmodic medication."

3"One of the best things I can do is use relaxation techniques."

4"The best position for me is to lie supine with my legs straight."

4"The best position for me is to lie supine with my legs straight."

A client with ulcerative colitis has a prescription to begin a salicylate compound medication to reduce inflammation. What instruction would the nurse give the client regarding when to take this medication?

On arising

2.After meals

3.On an empty stomach

4.30 minutes before meals

2.After meals

A client is admitted to the hospital with a diagnosis of acute diverticulitis. What would the nurse expect to be prescribed for this client?

1.NPO (nothing by mouth) status

2.Ambulation at least 4 times daily

3.Cholinergic medications to reduce pain

4.Coughing and deep breathing every 2 hours

1.NPO (nothing by mouth) status

The nurse would incorporate which in the dietary plan to ensure optimal nutrition for the client during the acute phase of hepatitis? Select all that apply.

1.Select foods high in protein content.

2.Consume multiple small meals throughout the day.

3.Select foods low in carbohydrates to prevent nausea.

4.Allow the client to select foods that are most appealing.

5.Eliminate fatty foods from the meal trays until nausea subsides.

6.Eat a nutritious dinner because it is typically the best tolerated meal of the day.

2.Consume multiple small meals throughout the day.

4.Allow the client to select foods that are most appealing.

5.Eliminate fatty foods from the meal trays until nausea subsides.

The nurse is caring for a postoperative client who has just returned from surgery for creation of a colostomy. The nurse inspects the colostomy stoma and recognizes that which is a normal assessment finding for this client?

1.A pale color

2.A purple color

3.A brick-red color

4.A large amount of red drainage

3.A brick-red color

A client is admitted to the hospital with a diagnosis of acute pancreatitis. Which would the nurse expect the client to report about the pain?

1.Eating helps to decrease the pain.

2.The pain usually increases after vomiting.

3.The pain is mostly around the umbilicus and comes and goes.

4.The pain increases when the client sits up and bends forward.

2.The pain usually increases after vomiting.

The nurse is performing an admission assessment on a client who has been admitted to the hospital with a diagnosis of suspected gastric ulcer. The nurse is asking the client questions about pain. Which client statement supports the diagnosis of gastric ulcer?

1."The pain doesn't usually come right after I eat."

2"The pain gets so bad that it wakes me up at night."

3"The pain that I get is located on the right side of my chest."

4"My pain comes shortly after I eat, maybe a half hour or so later."

4"My pain comes shortly after I eat, maybe a half hour or so later."

The nurse is caring for a client with acute pancreatitis. Which finding would the nurse expect to note when reviewing the laboratory results?

1.Elevated serum lipase level

2.Elevated serum bilirubin level

3.Decreased serum trypsin level

4Decreased serum amylase level

1.Elevated serum lipase level

The nurse plans care for a client postoperatively following creation of a colostomy. Which potential client problem would the nurse include in the plan of care?

1.Fear

2Anxiety

3.Inability to care for self

4.Upset about appearance

4.Upset about appearance

A client with cholecystitis is experiencing blockage of the common bile duct. Which food selection made by the client indicates the need for further teaching?

1.Rice

2.Whole milk

3.Broiled fish

4.Baked chicken

2.Whole milk

The nurse is performing discharge teaching for a client with chronic pancreatitis. Which information would the nurse include?

1.Alcohol needs to be consumed in moderation.

2.Avoid caffeine because it may aggravate symptoms.

3.Diet needs to be high in carbohydrates, fats, and proteins.

4.Frothy, fatty stools indicate that enzyme replacement is working.

2.Avoid caffeine because it may aggravate symptoms.

A client receiving a cleansing enema complains of pain and cramping. The nurse would take which corrective action?

1.Discontinue the enema.

2.Reassure the client, and continue the flow.

3.Raise the enema bag so that the solution can be completed quickly.

4Clamp the tubing for 30 seconds, and restart the flow at a slower rate.

4Clamp the tubing for 30 seconds, and restart the flow at a slower rate.

A client with a history of gastrointestinal upset has been diagnosed with acute diverticulitis. The nurse would anticipate a prescription from the primary health care provider for which type of diet for this client?

1.A low-fat diet

2.A low-fiber diet

3.A high-protein diet

4.A high-carbohydrate diet

2.A low-fiber diet

The nurse is caring for a client with cirrhosis. As part of dietary teaching to minimize the effects of the disorder, the nurse teaches the client about foods that are high in thiamine. The nurse determines that the client has the best understanding of the material if the client states to increase intake of which food?

1.Pork

2.Milk

3.Chicken

4Broccoli

1.Pork

A client is resuming a diet after hemigastrectomy, and the nurse provides dietary instructions. Which statement by the client indicates a need for further teaching?

1."I plan to lie down after eating."

2"I know to avoid sweets in my diet."

3"I will eat several small meals per day."

4"I will drink plenty of liquids with meals."

4"I will drink plenty of liquids with meals."

The nurse is providing discharge instructions for a client following a Roux-en-Y gastric bypass surgery 3 days ago. What will the nurse include in the instructions? Select all that apply.

1.Do not drink fluids with meals.

2.Avoid foods high in carbohydrates.

3.Take an extended-release multivitamin daily.

4.Maintain a clear liquid diet for about 6 weeks.

5.Eat 6 small meals a day that are high in protein.

1.Do not drink fluids with meals.

2.Avoid foods high in carbohydrates.

5.Eat 6 small meals a day that are high in protein.

The nurse cares for a client following a Roux-en-Y gastric bypass surgery. Which nursing intervention is appropriate?

1.Encourage the client to ambulate.

2Position the client on the left side.

3.Frequently irrigate the nasogastric tube (NG) with 30 mL saline.

4.Discourage the use of the patient-controlled analgesia (PCA) machine.

1.Encourage the client to ambulate.

The nurse is providing instructions to a client diagnosed with irritable bowel syndrome (IBS) who is experiencing abdominal distention, flatulence, and diarrhea. What interventions would the nurse plan to include in the instructions? Select all that apply.

1.Eat yogurt.

2.Take loperamide to treat diarrhea.

3.Use stress management techniques.

4.Avoid foods such as cabbage and broccoli.

5.Decrease fiber intake to less than 15 g/day.

1.Eat yogurt.

2.Take loperamide to treat diarrhea.

3.Use stress management techniques.

4.Avoid foods such as cabbage and broccoli.

The nurse is caring for a client experiencing an exacerbation of Crohn's disease. Which intervention would the nurse anticipate the primary health care provider prescribing?

1.Enteral feedings

2.Fluid restrictions

3.Oral corticosteroids

4.Activity restrictions

3.Oral corticosteroids

The nurse caring for a client diagnosed with inflammatory bowel disease (IBD) recognizes that which classifications of medications may be prescribed to treat the disease and induce remission? Select all that apply.

1.Antidiarrheal

2.Antimicrobial

3.Corticosteroid

4.Aminosalicylate

5.Biological therapy

6.Immunosuppressant

2.Antimicrobial

3.Corticosteroid

4.Aminosalicylate

5.Biological therapy

6.Immunosuppressant

The nurse is performing an assessment on a client with atrophic gastritis who has a diagnosis of pernicious anemia. Which finding would the nurse expect to note in this client?

1.Dyspnea

2.Dusky mucous membranes

3.Shortness of breath on exertion

4.Red tongue that is smooth and sore

4.Red tongue that is smooth and sore

A client is diagnosed with a moderate case of acute ulcerative colitis. The nurse doing dietary teaching would give the client examples of foods to eat that represent which therapeutic diet?

1.High fat with milk

2.Low fiber with milk

3.High protein with milk

4.Low fiber without milk

4.Low fiber without milk

The nurse is caring for a client who had a laparoscopic cholecystectomy 1 day ago. The nurse plans pain-management techniques, knowing that the severity of the client's pain can be related to which factor?

1.Positioning of the client during surgery

2.How long the client had pain before surgery

3.The type of general anesthesia used during surgery

4.The use of nonsteroidal anti-inflammatory medications before surgery

1.Positioning of the client during surgery

The nurse is assessing a client with complaints of weight loss, abdominal bloating, lack of appetite, diarrhea, and foul-smelling, fatty stools. Based on these complaints, the nurse would suspect which condition?

1.Celiac disease

2.Bowel obstruction

3.Hirschsprung's disease

4.Gastroesophageal reflux disease (GERD)

1.Celiac disease

The nurse is helping a client with celiac disease (CD) in ordering food. The nurse notes there is a need for further teaching if the client selects which food item?

1.Popcorn

2.Couscous

3.Fresh apple

4.Grilled chicken

2.Couscous

The nurse is caring for a client with suspected celiac disease undergoing diagnostic evaluation. Which laboratory tests would the nurse expect to be ordered to aid in the diagnosis of this disease?

1.IgA

2.IgM

3.IgG

4.IgD

1.IgA

The nurse is caring for a client with suspected celiac disease who had a skin biopsy of a red, pruritic lesion located on the buttocks. If the suspicious lesion is dermatitis herpetiformis, which skin biopsy result would the nurse expect?

1.IgA deposits in the dermis

2.IgG deposits in the dermis

3.IgD deposits in the dermis

4.IgM deposits in the dermis

1.IgA deposits in the dermis

The nurse is reviewing the pathophysiology of hypernatremia. The nurse correctly identifies which conditions as risk factors for hypernatremia? Select all that apply.

1.Diarrhea

2.Heart failure

3.Diabetes insipidus

4.Primary hyperaldosteronism

5.Syndrome of inappropriate antidiuretic hormone (SIADH)

1.Diarrhea

3.Diabetes insipidus

4.Primary hyperaldosteronism

The nurse is caring for a client with a serum sodium level of 149 mEq/L (149 mmol/L) concurrently experiencing fluid overload. Which clinical manifestations would the nurse expect? Select all that apply.

1.Agitation

2.Blood pressure 96/62

3.Intense thirst sensation

4.Bilateral 3+ pedal edema

5Clear lung sounds bilaterally

6.Weight gain of 7 pounds (3.2 kilograms) in 2 days

1.Agitation

3.Intense thirst sensation

4.Bilateral 3+ pedal edema

6.Weight gain of 7 pounds (3.2 kilograms) in 2 days

The nurse is caring for a client with a serum sodium level of 151 mEq/L (151 mmol/L) related to sodium excess. The client is experiencing central nervous system (CNS) symptoms, including agitation and twitching. The nurse would contact the primary health care provider for clarification if which intervention was included in the treatment plan?

1.Institute seizure precautions

2Measure strict intake and output

3Administer IV 5% dextrose in water

4Administer intravenous (IV) 0.9% sodium chloride

4Administer intravenous (IV) 0.9% sodium chloride

The nurse is caring for a client with a serum sodium level of 152 mEq/L (152 mmol/L) at 0400. The client’s serum sodium level is being closely monitored every 4 hours. The 0800 serum sodium level was 148 mEq/L (148 mmol/L) and the 1200 serum sodium level was 136 mEq/L (136 mmol/L). Which action would the nurse take?

1.Discontinue seizure precautions.

2.Increase the rate of intravenous fluids.

3.Contact the primary health care provider.

4Administer the next dose of diuretic as ordered.

3.Contact the primary health care provider.

The nurse is caring for a client with a serum sodium level of 151 mEq/L (151 mmol/L). Which priority assessment would the nurse include in the care plan for this client?

1.Lung sounds

2Bowel sounds

3Skin assessment

4Neurological assessment

4Neurological assessment

The nurse is reviewing the electrocardiogram (ECG) of a client with a potassium level of 5.6 mEq/L (5.6 mmol/L). Which may be noted on this client’s ECG? Select all that apply.

1.Wide, flat P wave

2.Prominent U wave

3Tall, peaked T wave

4.Narrow QRS complex

5.ST segment depression

1.Wide, flat P wave

3Tall, peaked T wave

5.ST segment depression

The nurse is caring for a client with a potassium level of 5.9 mEq/L and is assisting the client in choosing lunch. The nurse determines there is a need for further teaching if the client selects which food item from the menu?

1.Eggplant parmesan

2Tuna sandwich on white bread

3.Omelet with spinach, tomato, potatoes

4Pasta with marinara sauce and garlic bread

3.Omelet with spinach, tomato, potatoe

The nurse is providing dietary education to a client with gastroesophageal reflux disease (GERD). The nurse indicates that the client understands the teaching if the client states a plan to avoid which foods to prevent symptom exacerbation? Select all that apply.

1.Tea

2.Beer

3.Coffee

4.Oatmeal

5.Chocolate

6.Sweet potatoes

1.Tea

2.Beer

3.Coffee

5.Chocolate

A client asks the nurse what causes gastroesophageal reflux disease (GERD). Knowing that GERD has many causative factors, the nurse would list which as contributors to GERD? Select all that apply.

1.Rapid gastric emptying

2.Reduced esophageal motility

3.Reflux of bile from the small intestine

4.Lower esophageal sphincter dysfunction

5.Reflux of gastric contents into the esophagus

22.Reduced esophageal motility

3.Reflux of bile from the small intestine

4.Lower esophageal sphincter dysfunction

5.Reflux of gastric contents into the esophagus

The nurse is teaching a client with gastroesophageal reflux disease (GERD) about lifestyle modifications to take to reduce GERD symptoms. The nurse determines there is a need for further teaching if the client makes which statement?

1.“I will choose low-fat foods from now on.”

2“I would cut down on the amount of coffee I drink.”

3“I’ll avoid lying down for at least 3 hours after my last meal.”

4“Skipping breakfast and lunch and eating a large dinner will decrease my symptoms.”

4“Skipping breakfast and lunch and eating a large dinner will decrease my symptoms.”

The nurse is reinforcing education to a client diagnosed with gastroesophageal reflux disease (GERD) regarding surgical therapy for the condition. How would the nurse describe laparoscopic fundoplication?

1.“The fundus of the stomach is wrapped around the lower esophagus and then sutured in place.”

2.“A flexible scope is inserted down the esophagus and a balloon is inflated to dilate the esophagus.”

3.“A small, flexible ring of titanium magnets is placed laparoscopically into the lower esophageal sphincter.”

4“.Radiofrequency waves are delivered to the esophageal mucosa, which results in lesions that thicken the lower esophageal sphincter.”

1.“The fundus of the stomach is wrapped around the lower esophagus and then sutured in place.”

The nurse is teaching dietary modifications to a client diagnosed with gastroesophageal reflux disease (GERD). Which would the nurse recommend to prevent exacerbation of GERD symptoms? Select all that apply.

1.Oatmeal

2.Watermelon

3.Whole milk

4.Whole-grain brown rice

5.Carbonated seltzer water

1.Oatmeal

2.Watermelon

4.Whole-grain brown rice

The nurse is caring for a client recently diagnosed with a hiatal hernia, and the client asks the nurse to describe a hiatal hernia. How would the nurse respond?

1.“It occurs when a portion of your intestines protrudes through a healing surgical scar.”

2“It occurs when a portion of your intestines bulges through a weak spot in the inguinal canal.”

3.“It is when a portion of your intestines bulges through an abdominal wall opening near the navel.”

4.“It is the herniation of the upper part of the stomach into the esophagus through an opening in your diaphragm.”

4.“It is the herniation of the upper part of the stomach into the esophagus through an opening in your diaphragm.”

The nurse is caring for a client complaining of acid reflux and shortness of breath. A chest x-ray demonstrates protrusion of the upper portion of the stomach through the diaphragm. Which condition would the nurse suspect?

1.Esophagitis

2.Hiatal hernia

3.Umbilical hernia

4.Esophageal stricture

2.Hiatal hernia

The nurse is caring for a client diagnosed with a hiatal hernia. Which priority nursing action would the nurse include in the care plan for this client?

1.Offer the client small, frequent meals

2.Place the client in semi-Fowler's position

3.Teach the client to avoid lifting or straining

4.Encourage the client to drink fluids between meals

2.Place the client in semi-Fowler's position

The nurse is reinforcing education provided by the gastroenterologist regarding surgical techniques used to repair a hiatal hernia to a client diagnosed with a hiatal hernia. How would the nurse describe the gastropexy technique?

1.Removal of the herniated gastric sac

2.Closure of the hiatal defect in the diaphragm

3.The upper portion of the stomach is attached below the diaphragm.

4.The fundus of the stomach is wrapped around the distal portion of the esophagus and sutured together.

3.The upper portion of the stomach is attached below the diaphragm.

The client diagnosed with bilateral inguinal hernias requiring surgical repair asks the nurse to describe the condition. The nurse plans to make which appropriate nursing response?

1.“These types of hernias occur when abdominal contents protrude through weakened abdominal muscles near the navel."

2“These types of hernias occur when abdominal contents protrude through weakened abdominal muscles near the spermatic cord.”

3.“These types of hernias occur when abdominal contents protrude through weakened abdominal muscles near the site of a previous incision.”

4.“These types of hernias occur in the lower abdomen near the thigh when there is a protrusion of a loop of the intestine through a weakened abdominal wall.”

2.“These types of hernias occur when abdominal contents protrude through weakened abdominal muscles near the spermatic cord.”

The nurse is reviewing the clinical signs and symptoms of achalasia. Which are signs and symptoms of this disorder? Select all that apply.

1.Halitosis

2.Dysphagia

3.Weight gain

4.Frequent eructation

5.Substernal chest pain while eating

1.Halitosis

2.Dysphagia

5.Substernal chest pain while eating

The nurse is teaching a client diagnosed with achalasia about home care measures to improve symptoms associated with this disorder. Which instructions given by the nurse are appropriate? Select all that apply.

1.Do not eat meals quickly.

2.Elevate the head of the bed while sleeping.

3.Sip on fluids between bites while eating meals.

4.Choose softer fruits to eat rather than hard fruits.

5.Include a serving of raw vegetables with each meal.

1.Do not eat meals quickly.

2.Elevate the head of the bed while sleeping.

3.Sip on fluids between bites while eating meals.

4.Choose softer fruits to eat rather than hard fruits.

The nurse is creating a care plan for a client with achalasia. Because of the disorder, the client has difficulty swallowing and must follow a semisoft diet. The client expresses anxiety over eating and drinking fluids related to a fear of choking and an inability to hold eating utensils well, which is also contributing to the client’s constipation due to decreased fluid intake. Which would the nurse identify as the client's priority problem?

1.Anxiety

2.Constipation

3.Self-care deficit

4.Risk for aspiration

4.Risk for aspiration

The nurse is caring for a client with esophageal varices. Knowing the pathophysiology of this disorder, which other associated condition would the nurse suspect in the client?

1.Cirrhosis

2Appendicitis

3.Gastroenteritis

4.Tracheomalacia

1.Cirrhosis

The nursing instructor asks a nursing student which substance provides a protective function for the stomach against autodigestion and subsequent gastritis. The nursing student responds correctly by identifying which substance?

1.Pepsin

2.Gastrin

3.Ghrelin

4.Prostaglandins

4.Prostaglandins

The nurse caring for a client with chronic gastritis understands that the client is at risk for malnutrition. The client is at increased risk for malabsorption if which nutrient is deficient due to the lack of intrinsic factor (IF)?

1.Vitamin B₆

2.Vitamin B₁₂

3.Vitamin D

4.Vitamin K

2.Vitamin B₁₂

The nurse is caring for a client with new-onset abdominal pain who was diagnosed with acute gastritis. The client asks the nurse what may have caused this condition. Which of the following client factors increases the risk of acute gastritis? Select all that apply.

1.Helicobacter pylori infection.

2.Long-term corticosteroid therapy

3.Consuming multiple cups of coffee daily

4.Consuming five alcoholic beverages approximately 3 times per week

5.Taking ibuprofen approximately 2 times per month for headaches

1.Helicobacter pylori infection.

2.Long-term corticosteroid therapy

3.Consuming multiple cups of coffee daily

4.Consuming five alcoholic beverages approximately 3 times per week

The nurse is assessing a client diagnosed with acute gastritis. Which of the following clinical manifestations would the nurse expect? Select all that apply.

1.Nausea

2.Dyspepsia

3.Polyphagia

4.Hematemesis

5.Insidious onset of epigastric discomfort

1.Nausea

2.Dyspepsia

4.Hematemesis

The nurse is caring for a client with acute bacterial gastroenteritis. Which of the following primary health care provider prescriptions would require a need for follow-up?

1.Monitor strict intake and output

2.Administer IV ciprofloxacin as ordered

3.Administer 2 mg oral loperamide as needed every 6 hours for diarrhea

4.Administer intravenous (IV) 0.9% normal saline at 75 milliliters per hour (mL/hr)

3.Administer 2 mg oral loperamide as needed every 6 hours for diarrhea

The nurse is caring for a client with a bleeding gastric ulcer. The client begins to complain of severe, penetrating epigastric pain. Which initial action would the nurse take?

1.Perform an abdominal assessment

2.Prepare to insert a nasogastric tube

3.Contact the primary health care provider

4.Obtain the client’s blood type and crossmatch

1.Perform an abdominal assessment

The nurse is admitting a client with chronic peptic ulcer disease who is complaining of severe abdominal pain. Which order from the primary health care provider requires a need for follow-up?

1.Initiate the client on a nothing-by-mouth (NPO) diet.

2.Insert a nasogastric tube and attach to intermittent suction.

3.Obtain the client’s hemoglobin, hematocrit, and serum electrolyte levels.

4.Administer 15 milligrams (mg) ketorolac intravenously every 6 hours as needed for moderate pain.

4.Administer 15 milligrams (mg) ketorolac intravenously every 6 hours as needed for moderate pain.

The nurse is creating a care plan for a client diagnosed with peptic ulcer disease. The nurse plans care, knowing that ulcer perforation is a complication of this condition. Which sign or symptom is indicative of peptic ulcer perforation?

1.Dysuria

2.Polyphagia

3.A rigid, boardlike abdomen

4.Dull abdominal pain localized to the right lower quadrant

3.A rigid, boardlike abdomen

The nurse is teaching a client with peptic ulcer disease about lifestyle modifications to prevent exacerbations of the condition. The nurse determines that the client understood the instructions when the client states that which food item will be avoided?

1.Coffee

2.Oatmeal

3.Brown rice

4.Carbonated beverages

1.Coffee

The nurse is creating a care plan for a client diagnosed with a bleeding gastric ulcer related to Helicobacter pylori (H. pylori) infection. The nurse plans to monitor the client for which signs and symptoms that indicate an upper gastrointestinal (GI) bleed? Select all that apply.

1.Melena.

2.New-onset confusion

3.Coffee-ground vomitus

4.Bounding peripheral pulses

5.Heart rate below 60 beats per minute

1.Melena.

2.New-onset confusion

3.Coffee-ground vomitus

The nurse is reviewing the pathophysiology of bowel obstruction and the mechanical and nonmechanical causes of obstruction. Which would the nurse identify as a mechanical cause of intestinal obstruction? Select all that apply.

1.Paralytic ileus

2.Ventral hernia

3.Gastric malignancy

4.Bowel intussusception

5.Hirschsprung's disease

2.Ventral hernia

3.Gastric malignancy

4.Bowel intussusception

The nurse is creating a care plan for a client diagnosed with a nonmechanical small bowel obstruction. Which client data would the nurse identify as contributing factors to the development of a nonmechanical small bowel obstruction? Select all that apply.

1.Paralytic ileus

2.Intestinal stricture

3.Diverticular disease

4.Serum calcium 8.2 mg/dL (2.05 mmol/L)

5.Serum potassium 3.1 mEq/L (3.1 mmol/L)

1.Paralytic ileus

4.Serum calcium 8.2 mg/dL (2.05 mmol/L)

5.Serum potassium 3.1 mEq/L (3.1 mmol/L)

The nurse is assessing a client with nausea and vomiting. The client’s abdomen is distended, and the client reports being constipated and is unable to remember the date of the last bowel movement. Based on this client data, which condition would the nurse suspect?

1.Hepatitis

2.Esophagitis

3.Cholecystitis

4.Bowel obstruction

4.Bowel obstruction

The nurse is performing a gastrointestinal assessment on a client with a small bowel obstruction. The nurse notes that the client has absent bowel sounds. Which would the nurse suspect as the cause of the obstruction?

1.Paralytic ileus

2.Intestinal stricture

3.Intestinal adhesion

4.Intestinal intussusception

1.Paralytic ileus

The nurse is caring for a client with a small bowel obstruction located in the proximal jejunum. The nurse would monitor the client for which acid-base imbalances associated with this condition?

1.Metabolic acidosis

2.Metabolic alkalosis

3.Respiratory acidosis

4.Respiratory alkalosis

2.Metabolic alkalosis

The nurse is caring for a client diagnosed with a large duodenal ulcer. The client begins to complain of sudden, severe abdominal pain that radiates to the back and shoulders. The nurse further assesses the client and determines that the client’s bowel sounds are absent and respirations are shallow and rapid. Which complications would the nurse suspect?

1.Hepatitis

2.Appendicitis

3.Bowel perforation

4.Bowel obstruction

3.Bowel perforation

The nurse is caring for a client with a history of a small perforated duodenal ulcer that spontaneously healed on its own. The client asks the nurse about potential complications from a healed ulcer. The nurse would tell the client that which of the following is a complication of a self-healed duodenal ulcer?

1.Bowel stricture

2.Umbilical hernia

3.Esophageal varices

4.Barrett's esophagus

1.Bowel stricture

The nurse is caring for a client with a perforated duodenal ulcer. Which of the following imaging studies would the nurse anticipate the primary health care provider ordering to most accurately diagnose this condition?

1.Abdominal CT scan with no contrast

2.Right upper quadrant ultrasound (US)

3.Abdominal computed tomography (CT) scan with oral contrast

4.Abdominal magnetic resonance imaging (MRI) with intravenous (IV) contrast

3.Abdominal computed tomography (CT) scan with oral contrast

The nurse is reviewing the pathophysiology of bowel perforation. Which of the following would the nurse identify as a noniatrogenic cause of a bowel perforation?

1.Colonoscopy

2.Ruptured gastric ulcer

3.Explorative laparotomy

4.Esophagogastroduodenoscopy (EGD)

2.Ruptured gastric ulcer

The nurse is reviewing an abdominal x-ray series of a client diagnosed with bowel perforation. Which finding would the nurse anticipate on the client’s x-ray results?

1.Intraperitoneal gas

2.Dilated bowel loops

3.Multiple calcifications in the RUQ

4.Elongated soft tissue mass in the right upper quadrant (RUQ)

1.Intraperitoneal gas

The nursing instructor is reviewing the pathophysiology of gastrointestinal (GI) bleeding. The nursing instructor determines there is a need for further teaching if the nursing student identifies which of the following conditions as a cause of upper GI bleeding?

1.Peptic ulcer

2.Ulcerative colitis

3.Mallory-Weiss tear

4.Esophageal varices

2.Ulcerative colitis

The nurse is creating a care plan for a client diagnosed with gastrointestinal bleeding from a gastric ulcer. How would the nurse plan to monitor the client for occult signs of gastrointestinal bleeding?

1.Monitoring the client for black, tarry stools

2.Monitoring the client for coffee ground vomitus

3.Monitoring the client for bright red blood in stools

4.Monitoring the client’s respiratory rate and work of breathing

4.Monitoring the client’s respiratory rate and work of breathing

The nurse is caring for a client diagnosed with gastrointestinal bleeding from a Mallory-Weiss tear. In the care plan the nurse includes monitoring the client for signs and symptoms of shock. Which client data would alert the nurse that the client may be experiencing shock due to inadequate circulating volume related to blood loss? Select all that apply.

1.Blood pressure 128/88 mmHg

2.Heart rate 82 beats per minute (bpm)

3.Respiratory rate 18 breaths per minute

4.Mean arterial pressure (MAP) of 55 mm Hg

5.Urine output of 160 milliliters (mL) over the last 8 hours

4.Mean arterial pressure (MAP) of 55 mm Hg

5.Urine output of 160 milliliters (mL) over the last 8 hours

The nurse is reviewing the risk factors for lower gastrointestinal (GI) bleeding. Which of the following conditions would the nurse identify as a cause of lower GI bleeding? Select all that apply.

1.Anal fissure

2.Gastric ulcer

3.Diverticulitis

4.Hemorrhoids

5.Esophageal varices

1.Anal fissure

3.Diverticulitis

4.Hemorrhoids

The nurse is caring for a client diagnosed with a lower gastrointestinal (GI) bleed. Which of the following laboratory tests would the nurse anticipate being drawn? Select all that apply.

1.Hematocrit

2.Hemoglobin

3.Platelet count

4.Alanine transaminase (ALT)

5.Aspartate transaminase (AST)

6.Thyroid stimulating hormone (TSH)

1.Hematocrit

2.Hemoglobin

3.Platelet count

4.Alanine transaminase (ALT)

5.Aspartate transaminase (AST)

The nurse is caring for a client who underwent a fecal microbiota transplantation (FMT) to treat recurrent Clostridium difficile (C. difficile) infections. After the procedure, the client reports one episode of diarrhea and bloating. Which of the following actions would the nurse take next?

1.Collect a stool sample to test for ova and parasites

2.Immediately notify the primary health care provider

3.Reassure the client this is normal after this procedure

4.Increase the rate of intravenous (IV) fluids to compensate for fluid loss

3.Reassure the client this is normal after this procedure

The registered nurse (RN) is overseeing a new graduate nurse who is taking care of a client with a Clostridium difficile (C. difficile) infection. The RN would determine that the new graduate nurse requires a need for further teaching if the RN observes the new graduate nurse take which of the following actions during the care of this client?

1.Wearing a gown and gloves in the client’s room

2.Auscultating lung sounds with the nurse's own stethoscope

3.Washing hands thoroughly with soap and water after client contact

4.Cleaning contaminated surfaces in the client’s room with a 10% bleach solution

2.Auscultating lung sounds with the nurse's own stethoscope

The nurse is caring for a client currently being treated for a Clostridium difficile (C. difficile) infection. The client asks the nurse about factors that increase the risk of contracting this infection. The nurse would tell the client that which factors increase the risk of C. difficile infection? Select all that apply.

1.Age younger than 65 years

2.Living in a long-term care facility

3.History of previous C. difficile infection

4.Taking nitrofurantoin for a urinary tract infection (UTI)

5.Taking pantoprazole daily for gastroesophageal reflux disease (GERD)

2.Living in a long-term care facility

3.History of previous C. difficile infection

4.Taking nitrofurantoin for a urinary tract infection (UTI)

5.Taking pantoprazole daily for gastroesophageal reflux disease (GERD)

The nurse is caring for a client diagnosed with Clostridium difficile (C. difficile) infection. The nurse, who last assessed the client at the beginning of the shift, notes that the client’s abdomen has become further distended, bowel sounds are absent, the client’s heart rate has increased from 88 beats per minute to 104 beats per minute, and that the client is complaining of increasing abdominal pain. The nurse notes a change in the client’s baseline neurological status, as the client seems to be experiencing an altered level of consciousness. Which potential complication from C. difficile infection would the nurse suspect?

1.Colitis

2.Achalasia

3.Toxic megacolon

4.Bowel obstruction

3.Toxic megacolon

The nurse is caring for a client with Crohn’s disease. The client has poor oral intake and reports memory loss and weight loss. Upon assessment, the nurse notes a smooth tongue, which the client reports is sore; brittle nails; and pale skin. The client’s complete blood cell count (CBC) indicates a high mean corpuscular volume (MCV) and a low mean corpuscular hemoglobin (MCH). Based on the assessment, the nurse would suspect which nutrient deficiency?

1.Zinc deficiency

2.Calcium deficiency

3.Vitamin B₉ deficiency

4,Magnesium deficiency

3.Vitamin B₉ deficiency

The nurse is reviewing the laboratory results for a female client diagnosed with Crohn’s disease (CD). Which laboratory results would indicate that the client is experiencing an acute inflammatory process related to CD? Select all that apply.

1.Erythrocyte sedimentation rate (ESR) of 10 mm/hr

2.D-dimer of 75 ng/mL (4.5 mmol/L)

3.D-dimer of 40 ng/mL (2.4 mmol/L)

4.White blood cell count 9,000/mm³ (9 × 10⁹/L)

5.White blood cell (WBC) count of 14,000/mm³ (14 × 10⁹/L)

6.Erythrocyte sedimentation rate (ESR) of 30 mm/hr

2.D-dimer of 75 ng/mL (4.5 mmol/L)

5.White blood cell (WBC) count of 14,000/mm³ (14 × 10⁹/L)

6.Erythrocyte sedimentation rate (ESR) of 30 mm/hr

The nurse is assessing a client with ulcerative colitis (UC). The nurse is gathering information related to the client’s bowel habits, and the client reports having approximately five nonbloody stools a day. How would the nurse classify the severity of this client’s UC?

1.Mild

2.Severe

3.Moderate

4.Fulminant

3.Moderate

The nurse is assessing a client with ulcerative colitis (UC). How would the nurse classify the severity of the client’s UC if the client reports 12 bloody stools per day?

1.Mild

2.Severe

3.Moderate

4.Fulminant

4.Fulminant

A client diagnosed with a severe ulcerative colitis (UC) exacerbation has developed an intestinal abscess. The client asks the nurse to explain what this means. How would the nurse describe this complication?

1.“The bowel has developed localized pockets containing pus in the ulcerated bowel lining.”

2.“You are experiencing bleeding from your lower gastrointestinal tract (GI) due to bowel wall erosion.”

3.“This happens when the colon becomes extremely dilated and unable to move food contents through the GI tract.”

4.“An abnormal connection has developed between two organs due to chronic inflammation and tissue destruction.”

1.“The bowel has developed localized pockets containing pus in the ulcerated bowel lining.”

The nurse is performing an assessment on a client with suspected irritable bowel syndrome (IBS). Which laboratory test would the nurse anticipate being ordered to confirm this diagnosis?

1.Urea breath test

2.Chloride sweat test

3.Hydrogen breath test

4.Complete blood cell count

3.Hydrogen breath test

The nurse is assessing a client experiencing an exacerbation of irritable bowel syndrome (IBS) who is experiencing localized abdominal pain. The nurse prepares to perform abdominal palpation, knowing which of the following abdominal quadrants would most likely elicit tenderness with palpation due to this condition?

1.Left upper quadrant

2.Left lower quadrant

3.Right upper quadrant

4.Right lower quadrant

2.Left lower quadrant

The nurse is providing teaching to a client with suspected irritable bowel syndrome (IBS) who is scheduled to have a hydrogen breath test done to assist in confirming the diagnosis. Which of the following client statements would indicate a need for further teaching?

1.“I cannot have anything to eat or drink for at least 12 hours before the test.”

2“I cannot have anything to eat or drink besides water for at least 12 hours before the test.”

3“Additional breath samples may be taken every 15 minutes for a time period ranging from 1 to 5 hours.”

4“During the test, I will exhale into a hydrogen analyzer and then will eat small amounts of test sugar prior to giving additional breath samples.”

1.“I cannot have anything to eat or drink for at least 12 hours before the test.”

The nurse is reviewing the management plan for a client diagnosed with irritable bowel syndrome with predominant constipation (IBS-C). Which of the following primary health care provider (PHCP) orders would require a need for follow-up?

1.Encourage 8 to 10 glasses of water per day.

2.Administer linaclotide daily for constipation.

3.Administer loperamide as needed for constipation.

4.Administer psyllium in a glass of water at mealtimes.

3.Administer loperamide as needed for constipation.

The nurse is assessing a client diagnosed with irritable bowel syndrome (IBS). The nurse asks about the client’s bowel habits, and the client reports having several episodes of constipation that alternate with several episodes of diarrhea. Keeping the different types of IBS in mind, how would the nurse classify this client’s symptoms?

1.IBS-C

2.IBS-D

3.IBS-M

4.IBS-A

4.IBS-A

The nurse is assessing a client who was in a motor vehicle accident (MVA) and has abdominal contusions from the seat belt. The nurse plans care, knowing that the client is at risk for internal bleeding and subsequent hypovolemic shock. Which of the following signs and symptoms would alert the nurse of this potential complication? Select all that apply.

1.Hemoglobin 9 g/dL (90 g/L)

2.Blood pressure 88/60 mmHg

3.Heart rate 88 beats per minute

4.A soft, nondistended abdomen

5.Respiratory rate 24 breaths per minute

1.Hemoglobin 9 g/dL (90 g/L)

2.Blood pressure 88/60 mmHg

5.Respiratory rate 24 breaths per minute

The nurse is caring for a client who sustained abdominal injuries in a motor vehicle accident. Which laboratory result would alert the nurse the client sustained kidney damage?

1.Urinalysis negative for protein

2.Creatinine 0.8 mg/dL (70.4 mcmol/L)

3.Urinalysis positive for trace amounts of blood

4.Blood urea nitrogen (BUN) 12 mg/dL (4.32 mmol/L)

3.Urinalysis positive for trace amounts of blood

The nurse is caring for a client who sustained abdominal injuries in a motor vehicle accident. Which of the following client data would prompt the nurse to contact the primary health care provider (PHCP)?

1.Blood pressure 110/78 mm Hg

2Heart rate 94 beats per minute

3Active bowel sounds in all quadrants

4.Urine output of 175 milliliters (mL) over the last 10 hours

4.Urine output of 175 milliliters (mL) over the last 10 hours

The emergency department nurse is admitting a client who sustained a pelvic fracture in a motor vehicle accident. Physical assessment reveals ecchymoses and abrasions across the client’s abdomen. The nurse reviews the emergency department provider’s orders and would contact the emergency department provider for clarification regarding which order?

1.Insert a nasogastric tube.

2Insert an indwelling urinary catheter.

3.Obtain blood for type and crossmatch.

4.Insert two large-bore catheters to establish intravenous (IV) access.

2Insert an indwelling urinary catheter.

The emergency department nurse is admitting a client who sustained several traumatic injuries after being hit by a car while crossing the street. The client has signs and symptoms of abdominal trauma in addition to several other injuries. The client’s imaging results indicate a fractured mandible. Computed tomography (CT) scans are pending, but the client’s pelvic x-ray is negative for fracture. The nurse reviews the incoming orders in the client’s medical record. Which primary health care provider (PHCP) order would prompt the nurse to contact the PHCP for clarification?

1.Obtain a urinalysis.

2.Insert a nasogastric tube.

3.Insert an indwelling urinary catheter.

4.Obtain a complete blood cell count (CBC).

2.Insert a nasogastric tube.

The nurse is performing a gastrointestinal (GI) assessment on a client with suspected appendicitis. The nurse assesses for pain at McBurney’s point, knowing this landmark is located where on the abdomen?

1.Halfway between the umbilicus and left iliac crest

2.Halfway between the umbilicus and right iliac crest

3.Halfway between the left ischial tuberosity and iliac crest

4.Halfway between the right ischial tuberosity and right iliac crest

2.Halfway between the umbilicus and right iliac crest

A client with viral hepatitis states, "I am so yellow." What is the most appropriate nursing action?

1.Assist the client in expressing feelings.

2.Restrict visitors until the jaundice subsides.

3.Perform most of the activities of daily living for the client.

4.Provide information to the client only when requested.

1.Assist the client in expressing feelings.

The nurse checks the gastric residual of an unconscious client receiving nasogastric tube feedings continuously at 50 mL/hr. The nurse notes that the residual is 250 mL at 0800 and 300 mL at 0900. The nurse determines that the client is experiencing which complication?

1.Air in the stomach

2.Too slow an infusion rate

3.Delayed gastric emptying

4.Early signs of peptic ulcer

3.Delayed gastric emptying

The nurse has been caring for a client who required a Sengstaken-Blakemore tube because other treatment measures for esophageal varices were unsuccessful. The primary health care provider (PHCP) arrives on the nursing unit and deflates the esophageal balloon. Which assessment finding by the nurse is the most important and would be reported to the PHCP immediately?

1.Hematemesis

2.Bloody diarrhea

3.Swelling of the abdomen

4.An elevated temperature and a rise in blood pressure

1.Hematemesis

The nurse is reviewing the record of a client admitted to the nursing unit and notes that the client has a history of Laënnec's cirrhosis. Which question related to the client's history would be most important to ask?

1."Do you abuse alcohol?"

2"Do you have any known cardiac disease?"

3"Does your type of employment cause you to have exposure to chemicals?"

4"Have you ever been told that you have had obstruction to your biliary ducts?"

1."Do you abuse alcohol?"

The nurse is caring for a client with a small bowel obstruction who is prescribed a nasogastric (NG) tube for the purpose of stomach decompression. The nurse would anticipate a primary health care provider prescription for which type of suction?

1.Low and continuous

2.High and continuous

3.High and intermittent

4.Low and intermittent

4.Low and intermittent

The nurse is caring for a client with acute respiratory distress syndrome on a mechanical ventilator who has a nasogastric tube in place. The nurse is assessing the pH of the gastric aspirate and notes that the pH is 4.5. Based on this finding, the nurse would take which action?

1.Document the findings.

2.Reassess the pH in 4 hours.

3.Instill 30 mL of sterile water.

4.Administer a dose of a prescribed antacid.

4.Administer a dose of a prescribed antacid.

The nurse is caring for a client with gastroesophageal reflux disease (GERD) and provides client education on measures to decrease GERD. Which statement made by the client indicates a need for further teaching?

1."I plan to eat four to six small meals a day."

2."I need to sleep in the right side-lying position."

3."I plan to have a snack 1 hour before going to bed."

4"I will stop having a glass of wine each evening with dinner."

3."I plan to have a snack 1 hour before going to bed."

The nurse is completing an admission assessment for a client with suspected esophageal cancer. Which statement made by the client indicates the presence of a risk factor for esophageal cancer?

1."I've been smoking for 20 years now."

2"I eat plenty of fresh fruits and vegetables."

3"I'm 5 feet, 8 inches tall and weigh 160 pounds."

4"My alcohol consumption is about 2 beers per month."

1."I've been smoking for 20 years now."

The nurse teaches a preoperative client about the use of a nasogastric (NG) tube for the planned surgery. Which statement indicates to the nurse that the client understands when the tube can be removed in the postoperative period?

1."When I can tolerate food without vomiting."

2"When my gastrointestinal system is healed enough."

3"When my bowels begin to function again, and I begin to pass gas."

4"When my primary health care provider says the tube can come out."

3."When my bowels begin to function again, and I begin to pass gas."

Pancreatin is prescribed for a client with postgastrectomy syndrome. Which assessment finding would indicate a therapeutic effect of this medication?

1.Pancreatin is prescribed for a client with postgastrectomy syndrome. Which assessment finding would indicate a therapeutic effect of this medication?

The client's appetite improves.

2The client experiences weight loss.

3.Vitamin B₁₂ deficiency is controlled.

4The stool is less fatty and decreases in frequency.

4.The stool is less fatty and decreases in frequency.

The nurse caring for a client diagnosed with inflammatory bowel disease (IBD) recognizes that which classifications of medications may be prescribed to treat the disease and induce remission? Select all that apply.

1.Antidiarrheal

2.Antimicrobial

3.Corticosteroid

4.Aminosalicylate

5.Biological therapy

6.Immunosuppressant

2.Antimicrobial

3.Corticosteroid

4.Aminosalicylate

5.Biological therapy

6.Immunosuppressant

The primary health care provider (PHCP) arrives on the nursing unit and deflates the esophageal balloon of a Sengstaken-Blakemore tube in a client with cirrhosis. The nurse would contact the PHCP immediately if which occurs?

1.The client has some diarrhea that is bloody.

2.The client's blood pressure is 128/78 mm Hg.

3.The client complains of abdominal discomfort.

4.The client complains of nausea and vomits blood.

4.The client complains of nausea and vomits blood.

The nurse is monitoring a client who required a Sengstaken-Blakemore tube because other measures for treating bleeding esophageal varices were unsuccessful. The client complains of severe pain of abrupt onset. Which nursing action is most appropriate?

The nurse, caring for a group of adult clients on an acute care medical-surgical nursing unit, determines that which clients would be the most likely candidates for total parenteral nutrition (TPN)? Select all that apply.

1.A client with extensive burns

2.A client with cancer who is septic

3.A client who has had an open cholecystectomy

4.A client with severe exacerbation of Crohn's disease

5.A client with persistent nausea and vomiting from chemotherapy

1.A client with extensive burns

2.A client with cancer who is septic

4.A client with severe exacerbation of Crohn's disease

5.A client with persistent nausea and vomiting from chemotherapy

A client reports ingesting large amounts of oral antacids on a daily basis because of a gastric ulcer. The nurse plans care, knowing that the excessive use of oral antacids containing bicarbonate can result in which acid-base disturbance?

1.Metabolic acidosis

2.Metabolic alkalosis

3.Respiratory acidosis

4.Respiratory alkalosis