Gastrointestinal 2

55問 • 1年前

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A nurse is preparing a teaching plan for a client with a history of cholelithiasis. Which information about why the ingestion of fatty foods will cause discomfort should the nurse include in the teaching plan?

Bile flow into the intestine is obstructed.

A nurse is caring for a client with cholelithiasis and obstructive jaundice. When assessing this client, the nurse should be alert for which common clinical indicators associated with these conditions? Select all that apply.

Ecchymosis, Yellow sclera, Pain in right upper quadrant

For which clinical indicators should the nurse monitor when caring for a client with cholelithiasis and obstructive jaundice? Select all that apply.

Dark urine, Yellow skin, Clay-colored stool

Before a cholecystectomy vitamin K is prescribed. Which element, formed in the presence of vitamin K, should the nurse determine is the purpose of administering this medication?

Prothrombin

A client is returned to the surgical unit after an abdominal cholecystectomy. What is the main reason why the nurse should assess for clinical indicators of respiratory complications?

Incision is in close proximity to the client’s diaphragm.

A client with a history of pancreatitis is scheduled for surgery to excise a pseudocyst of the pancreas. The client asks, “What is a pseudocyst?” What information should the nurse include in a response to this question?

Dilated space of necrotic tissue and blood

A nurse is caring for a client with a diagnosis of acute pancreatitis and alcoholism. The client asks, “What does my drinking have to do with my diagnosis?” What effect of alcohol should the nurse include when responding?

Increases enzyme secretion and pancreatic duct pressure that causes backflow of enzymes into the pancreas

A client is diagnosed with cancer of the pancreas and is apprehensive and restless. Which nursing action should be included in the plan of care?

Encouraging expression of concerns

A client is admitted with a tentative diagnosis of pancreatitis. The medical and nursing measures for this client are aimed toward maintaining nutrition, promoting rest, maintaining fluid and electrolyte balance, and decreasing anxiety. Which interventions should the nurse implement? Select all that apply.

Administer analgesics., Teach relaxation exercises., Monitor cardiac rate and rhythm.

A client is recovering from an acute episode of alcoholism that included esophageal involvement. What are the com- ponents of a therapeutic diet that are most appropriate for the nurse to include in the teaching plan for this client? Select all that apply.

Soft diet, High-protein diet, High-carbohydrate diet

Thiamine (vitamin B1) and niacin (vitamin B3) are prescribed for a client with alcoholism. Which body function maintained by these vitamins should the nurse include in a teaching plan?

Neuronal activity

A client is admitted to the hospital with a diagnosis of alcohol withdrawal syndrome. What body organ should the nurse teach the client will be protected by the ingestion of a high-calorie diet fortified with vitamins?

Liver

A nurse is teaching a class about hepatitis, specifically hepatitis A. Which food should the nurse explain will most likely remain contaminated with the hepatitis A virus after being cooked?

Steamed lobster

A client with hepatitis B asks the nurse, “Are there any medications to help me get rid of this problem?” Which is the best response by the nurse?

“There are medications to help reduce viral load and liver inflammation.”

A nurse is teaching a client about prophylactic measures that minimize the risk of contracting hepatitis B. Which actions should be included in this teaching plan? Select all that apply.

Screening of blood donors, Maintaining a monogamous sexual relationship

A nurse is caring for a client who is positive for hepatitis A. What should the nurse do?

Use gloves when removing the client’s bedpan.

A client who is about to have a blood transfusion asks the nurse, “Which type of hepatitis is most frequently transmit- ted by transfusions?” The nurse should respond, “Although the risk is minimal, the type of hepatitis associated with blood transfusions is hepatitis:

C.”

A nurse instructs a client with viral hepatitis about the type of diet that should be ingested. Which lunch selected by the client indicates understanding about dietary principles associated with this diagnosis?

Salad, sliced chicken sandwich, gelatin dessert

A client has developed hepatitis A after eating con- taminated oysters. The nurse assesses the client for which expected assessment finding?

Malaise

A client suspected of having a duodenal ulcer has undergone esophagogastroduodenoscopy. The nurse would place highest priority on which item as part of the client’s care plan?

Assessing for the return of the gag reflex

The nurse has taught the client with suspected gall- bladder disease about an upcoming endoscopic retrograde cholangiopancreatography (ERCP) pro- cedure. The nurse determines that the client needs further information if the client makes which state- ment?

“I’m glad I don’t have to lie still for this procedure.”

The primary health care provider has determined that a client has contracted hepatitis A based on flulike symptoms and jaundice. Which statement made by the client supports this medical diagnosis?

“I ate shellfish about 2 weeks ago at a local restaurant.”

The nurse is assessing a client 24 hours after a chol- ecystectomy. The nurse notes that the T-tube has drained 750 mL of green-brown drainage since the surgery. Which nursing intervention is most appro- priate?

Document the findings.

The nurse is monitoring a client with a diagnosis of peptic ulcer. Which assessment finding would most likely indicate perforation of the ulcer?

A rigid, boardlike abdomen

A client with severe ulcer disease in the distal stom- ach undergoes a gastrojejunostomy (Billroth II pro- cedure). Which postoperative prescription would the nurse question and verify?

Irrigating the nasogastric tube

The nurse is providing discharge instructions to a client following gastrectomy and would instruct the client to take which measure to assist in preventing dumping syndrome?

Limit the fluids taken with meals.

The nurse is reviewing the prescription for a client admitted to the hospital with a diagnosis of acute pancreatitis. Which interventions would the nurse expect to be prescribed for the client? Select all that apply.

Maintain NPO (nothing by mouth) status, Encourage coughing and deep breathing., Give hydromorphone intravenously as prescribed for pain.

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?

“I need to increase the fiber in my diet.”

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

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?

Pasta with sauce

The nurse is doing an admission assessment on a client with a history of duodenal ulcer. To deter- mine whether the problem is currently active, the nurse would assess the client for which manifesta- tion of duodenal ulcer?

Pain relieved by food intake

A client with hiatal hernia chronically experiences heartburn following meals. The nurse would plan to teach the client to avoid which action because it is contraindicated with a hiatal hernia?

Lying recumbent following meals

The nurse is providing care for a client with a bowel obstruction who had a transverse colostomy creat- ed. Which observation requires immediate notification of the primary health care provider?

Purple discoloration of the stoma

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

This is a normal, expected event.

A client with severe Crohn’s disease has just had sur- gery to create an ileostomy. The nurse assesses the cli- ent in the immediate postoperative period for which most frequent complication of this type of surgery?

Fluid and electrolyte imbalance

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

“I need to limit my intake of dietary fiber.”

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

Sweating and pallor

Which of the following factors is believed to cause ulcerative colitis?

Altered immunity

Fistulas are most common with which of the following bowel disorders?

Crohn’s disease

Arya is a community health nurse who has just finished organizing a program on oral health and smoking cessation. One of the participants of the program asked what intervention is most appropriate for stomatitis. How should the nurse respond to this?

Eating a soft, bland, diet

Arya is a community health nurse who has just finished organizing a program on oral health and smoking cessation. A member of the community who is schedule for a dental appointment after the program asked whether him having a history of mitral valve prolapse is significant. Which of the following replies is most appropriate?

"We will prescribe a prophylactic antibiotic for you to take before getting your teeth cleaned."

Arya is a community health nurse who has just finished organizing a program on oral health and smoking cessation. Which of the following lesions are commonly associated with oral cancer?

Red or white patches in the mouth or throat

Arya is a community health nurse who has just finished organizing a program on oral health and smoking cessation. A group of men who regularly chew tobacco have asked about warning signs that they need to report to their physicians. The following symptoms should be reported, EXCEPT:

Sensitive teeth

Relief of epigastric pain after eating

Sansa, a 34 year old lawyer, has been admitted to the hospital with complaints of stomach pain and suspected peptic ulcer disease. The nurse will now help prepare her for various investigations and treatment to help alleviate symptoms associated with this condition. Sansa has just come back to her room following an upper GI endoscopy. The nurse has assigned a student nurse to monitor the patient’s vital signs every 30 minutes for the next two hours. One hour after Sansa came back to her room, the student nurse reports that the client, who was previously afebrile, has developed a temperature of 38.8 degrees Celsius. What should the nurse do in response to this assessment data?

Assess the client for potential perforation

Limit gastric acid secretion

Any foods that are tolerated

Sansa, a 34 year old lawyer, has been admitted to the hospital with complaints of stomach pain and suspected peptic ulcer disease. The nurse will now help prepare her for various investigations and treatment to help alleviate symptoms associated with this condition. Just as Sansa was about to be discharged, she starts vomiting bright red blood, develops a sudden sharp pain in the mid-epigastric region along with a rigid, board-like abdomen. These clinical manifestations suggest that the client has developed which of the following?

A perforated ulcer

Ned is a 65-year-old male who has been admitted to the hospital for a planned gastrectomy following a recent diagnosis of stomach cancer. A student nurse caring for Ned asks the nurse about the risk factors for gastric cancer. The following significantly increase the risk for gastric cancer, EXCEPT:

A diet high in proteins

Ned is a 65-year-old male who has been admitted to the hospital for a planned gastrectomy following a recent diagnosis of stomach cancer. The nurse knows that 90 to 95% of gastric cancers arise from which part of the stomach?

Mucus producing cells of the stomach

Ned is a 65-year-old male who has been admitted to the hospital for a planned gastrectomy following a recent diagnosis of stomach cancer. The surgeon has ordered an Esophagogastroduodenoscopy (EGD) to be done prior to surgery. The nurse would anticipate that the patient would most likely be in which position for the procedure?

Left lateral

Ned is a 65-year-old male who has been admitted to the hospital for a planned gastrectomy following a recent diagnosis of stomach cancer. Immediately following an EGD under sedation, the nurse would prioritize assessing which of the following parameters?

Oxygen saturations

Nurse Robb is caring for a 76-year old patient who has just returned to the unit following a subtotal gastrectomy. Nurse Robb is examining the drainage coming from the patient’s nasogastric tube. What color would be expected for about 12 to 24 hours after surgery?

Dark brown

Nurse Robb is caring for a 76-year old patient who has just returned to the unit following a subtotal gastrectomy. Care of the client’s nasogastric tube would include which of the following nursing interventions?

Monitor the client for nausea, vomiting, and abdominal distention

Nurse Robb is caring for a 76-year old patient who has just returned to the unit following a subtotal gastrectomy. To reduce the risk of dumping syndrome following a gastrectomy, the nurse should teach the client to do which of the following?

Decrease the carbohydrate content of meals

Astignars random QS

Kyla Angelique Son · 19問 · 1年前

Astignars random QS