2. You’re assessing the stoma of a patient with a
healthy, well-healed colostomy. You expect the stoma to appear: 3. You’re caring for a patient with a sigmoid colostomy. The stool from this colostomy is: 4. You’re advising a 21 y.o. with a colostomy who reports problems with flatus. What food should you recommend? 5. You have to teach ostomy self care to a patient with a colostomy. You tell the patient to measure and cut the wafer: 6. You’re performing an abdominal assessment on Brent who is 52 y.o. In which order do
you proceed? 7. You’re doing preoperative teaching with Gertrude who has ulcerative colitis who needs surgery to create an ileoanal reservoir. Which information do you include? 8. You’re caring for Carin who has just had ileostomy surgery. During the first 24 hours post-op, how much drainage can you expect from the ileostomy? 9. You’re preparing a teaching plan for a 27 y.o.
named Jeff who underwent surgery to close a temporary ileostomy. Which nutritional guideline do you include in this plan? 10. Arthur has a family history of colon cancer and is scheduled to have a sigmoidoscopy. He is crying as he tells you, “I know that I have colon cancer, too.” Which response is most
therapeutic? 11. You’re caring for Beth who underwent a Billroth II procedure (surgical removal of the pylorus and duodenum) for treatment of a peptic ulcer. Which findings suggest that the patient is developing dumping syndrome, a complication associated with this procedure? 12. You’re developing the plan of care for a patient experiencing dumping syndrome after a Billroth II procedure. Which dietary instructions do you include? 13. You’re caring for Lewis, a 67 y.o. patient with liver cirrhosis who develops ascites
and requires paracentesis. Relief of which symptom indicated that the paracentesis was effective? 14. You’re caring for Jane, a 57 y.o. patient with liver cirrhosis who develops ascites and requires paracentesis. Before her paracentesis, you instruct her to: 15. After abdominal surgery, your patient has a severe coughing episode that causes wound evisceration. In addition to calling the doctor, which intervention is most appropriate? 16. You’re caring for Betty with liver cirrhosis.
Which of the following assessment findings leads you to suspect hepatic encephalopathy in her? 17. You are developing a careplan on Sally, a 67 y.o. patient with hepatic encephalopathy. Which of the following do you include? 18. You have a patient with achalasia (incomplete muscle relaxtion of the GI tract, especially sphincter muscles). Which medications do you anticipate to administer? 19. The student nurse is preparing a teaching care plan to help improve nutrition in a patient with achalasia. You include which of the
following: 20. Britney, a 20 y.o. student is admitted with acute pancreatitis. Which laboratory findings do you expect to be abnormal for this patient? 21. A patient with Crohn’s disease is admitted after 4 days of diarrhea. Which of the following urine specific gravity values do you expect to find in this patient? 22. Your goal is to minimize David’s risk of complications after a heriorrhaphy. You instruct the patient to: 23. Janice is waiting for discharge instructions after her herniorrhaphy. Which of the following instructions do you include? 24. Develop a teaching care plan for Angie who is about to undergo a liver biopsy. Which of the following points do
you include? 25. Stephen is a 62 y.o. patient that has had a liver biopsy. Which of the following groups of signs alert you to a possible pneumothorax? 26. Michael, a 42 y.o. man is admitted to the med-surg floor with a diagnosis of acute pancreatitis. His BP is 136/76, pulse 96, Resps 22 and temp 101. His past history includes hyperlipidemia and alcohol abuse. The doctor prescribes an NG tube. Before inserting the tube, you explain the purpose to
patient. Which of the following is a most accurate explanation? 27. Jason, a 22 y.o. accident victim, requires an NG tube for feeding. What should you immediately do after inserting an NG tube for liquid enteral feedings? 28. Stephanie, a 28 y.o. accident victim, requires TPN. The rationale for TPN is to provide: 29. Type A chronic gastritis can be distinquished from type B by its ability to: 30. Matt is a 49 y.o. with a hiatal hernia that you are about to counsel. Health care counseling for Matt should include which of the following
instructions? 31. Jerod is experiencing an acute episode of ulcerative colitis. Which is priority for this patient?
32. A 29 y.o. patient has an acute episode of ulcerative colitis. What diagnostic test confirms this diagnosis?
33. Eleanor, a 62 y.o. woman with diverticulosis is your patient. Which interventions would you expect to include in her care?
34. Regina is a 46 y.o. woman with ulcerative colitis. You expect her stools to look like:
35. Donald is a 61 y.o. man with diverticulitis. Diverticulitis is characterized by:
36. Brenda, a 36 y.o. patient is on your floor with acute pancreatitis. Treatment for her includes:
37. Glenda has cholelithiasis (gallstones). You expect her to complain of:
38. After an abdominal resection for colon cancer, Madeline returns to her room with a Jackson-Pratt drain in place. The purpose of the drain is to:
39. Anthony, a 60 y.o. patient, has just undergone a bowel resection with a colostomy. During the first 24 hours, which of the following observations about the stoma should you report to the doctor?
40. Your teaching Anthony how to use his new colostomy. How much skin should remain exposed between the stoma and the ring of the appliance?
41. Claire, a 33 y.o. is on your floor with a possible bowel obstruction. Which intervention is priority for her?
42. Your patient has a GI tract that is functioning, but has the inability to swallow foods. Which is the preferred method of feeding for your patient?
43. You’re patient is complaining of abdominal pain during assessment. What is your priority?
44. Before bowel surgery, Lee is to administer enemas until clear. During administration, he complains of intestinal cramps. What do you do next?
45. Leigh Ann is receiving pancrelipase (Viokase) for chronic pancreatitis. Which observation best indicates the treatment is effective?
46. Ralph has a history of alcohol abuse and has acute pancreatitis. Which lab value is most likely to be elevated?
47. Anna is 45 y.o. and has a bleeding ulcer. Despite multiple blood transfusions, her HGB is 7.5g/dl and HCT is 27%. Her doctor determines that surgical intervention is necessary and she undergoes partial gastrectomy. Postoperative nursing care includes:
48. Sitty, a 66 y.o. patient underwent a colostomy for ruptured diverticulum. She did well during the surgery and returned to your med-surg floor in stable condition. You assess her colostomy 2 days after surgery. Which finding do you report to the doctor?
49. Sharon has cirrhosis of the liver and develops ascites. What intervention is necessary to decrease the excessive accumulation of serous fluid in her peritoneal cavity?
50. Katrina is diagnosed with lactose intolerance. To avoid complications with lack of calcium in the diet, which food should be included in the diet?
51. Nathaniel has severe pruritus due to having hepatitis B. What is the best intervention for his comfort?
52. Rob is a 46 y.o. admitted to the hospital with a suspected diagnosis of Hepatitis B. He’s jaundiced and reports weakness. Which intervention will you include in his care?
53. You’re discharging Nathaniel with hepatitis B. Which statement suggests understanding by the patient?
54. Gail is scheduled for a cholecystectomy. After completion of preoperative teaching, Gail states,”If I lie still and avoid turning after the operation, I’ll avoid pain. Do you think this is a good idea?” What is the best response?
55. You’re caring for a 28 y.o. woman with hepatitis B. She’s concerned about the duration of her recovery. Which response isn’t appropriate?
56. Elmer is scheduled for a proctoscopy and has an I.V. The doctor wrote an order for 5mg of I.V. diazepam(Valium). Which order is correct regarding diazepam?
57. Annebell is being discharged with a colostomy, and you’re teaching her about colostomy care. Which statement correctly describes a healthy stoma?
58. A patient who underwent abdominal surgery now has a gaping incision due to delayed wound healing. Which method is correct when you irrigate a gaping abdominal incision with sterile normal saline solution, using a piston syringe?
59. Hepatic encephalopathy develops when the blood level of which substance increases?
60. Your patient recently had abdominal surgery and tells you that he feels a popping sensation in his incision during a coughing spell, followed by severe pain. You anticipate an evisceration. Which supplies should you take to his room?
61. Findings during an endoscopic exam include a cobblestone appearance of the colon in your patient. The findings are characteristic of which disorder?
62. What information is correct about stomach cancer?
63. Dark, tarry stools indicate bleeding in which location of the GI tract?
64. A patient has an acute upper GI hemorrhage. Your interventions include:
65. You promote hemodynamic stability in a patient with upper GI bleeding by:
66. You’re preparing a patient with a malignant tumor for colorectal surgery and subsequent colostomy. The patient tells you he’s anxious. What should your initial step be in working with this patient?
67. Your patient, Christopher, has a diagnosis of ulcerative colitis and has severe abdominal pain aggravated by movement, rebound tenderness, fever, nausea, and decreased urine output. This may indicate which complication?
68. A patient has a severe exacerbation of ulcerative colitis. Long-term medications will probably include:
69. The student nurse is teaching the family of a patient with liver failure. You instruct them to limit which foods in the patient’s diet?
70. An intubated patient is receiving continuous enteral feedings through a Salem sump tube at a rate of 60ml/hr. Gastric residuals have been 30-40ml when monitored Q4H. You check the gastric residual and aspirate 220ml. What is your first response to this finding?
71. Your patient with peritonitis is NPO and complaining of thirst. What is your priority?
72. Kevin has a history of peptic ulcer disease and vomits coffee-ground emesis. What does this indicate?
73. A 53 y.o. patient has undergone a partial gastrectomy for adenocarcinoma of the stomach. An NG tube is in place and is connected to low continuous suction. During the immediate postoperative period, you expect the gastric secretions to be which color?
74. Your patient has a retractable gastric peptic ulcer and has had a gastric vagotomy. Which factor increases as a result of vagotomy?
75. Christina is receiving an enteral feeding that requires a concentration of 80ml of supplement mixed with 20 ml of water. How much water do you mix with an 8 oz (240ml) can of feeding?
76. Which stoma would you expect a malodorous, enzyme-rich, caustic liquid output that is yellow, green, or brown?
77. George has a T tube in place after gallbladder surgery. Before discharge, what information or instructions should be given regarding the T tube drainage?
78. Your patient Maria takes NSAIDS for her degenerative joint disease, has developed peptic ulcer disease. Which drug is useful in preventing NSAID-induced peptic ulcer disease?
79. The student nurse is participating in colorectal cancer-screening program. Which patient has the fewest risk factors for colon cancer?
80. You’re patient, post-op drainage of a pelvic abscess secondary to diverticulitis, begins to cough violently after drinking water. His wound has ruptured and a small segment of the bowel is protruding. What’s your priority?
10. B Making observations about what you see or hear is a useful therapeutic technique. This way, you acknowledge that you are interested in what the patient is saying and feeling. 11. C After a Billroth II procedure, a large amount of hypertonic fluid enters the intestine. This causes extracellular fluid to move rapidly into the bowel, reducing circulating blood volume and producing vasomotor symptoms. Vasomotor symptoms produced by dumping syndrome include dizziness and sweating, tachycardia, syncope, pallor, and palpitations. 12. A Gastric emptying time can be delayed by omitting fluids from your patient’s meal. A diet low in carbs and high in fat & protein is recommended to treat dumping syndrome. 13. B Ascites puts pressure on the diaphragm. Paracentesis is done to remove fluid and reducing pressure on the diaphragm. The goal is to improve the patient’s breathing. The others are signs of cirrhosis that aren’t relieved by paracentesis. 14. A A full bladder can interfere with paracentesis and be punctured inadvertently. 15. B Cover the organs with a sterile, nonadherent dressing moistened with normal saline. Do this to prevent infection and to keep the organs from drying out. 16. A Asterixis is an early neurologic sign of hepatic encephalopathy elicited by asking the patient to hold her arms stretched out. Asterixis is present if the hands rapidly extend and flex. 17. A You may administer the laxative lactulose to reduce ammonia levels in the colon. 18. A Achalasia is characterized by incomplete relaxation of the LES, dilation of the lower esophagus, and a lack of esophageal peristalsis. Because nitrates relax the lower esophageal sphincter, expect to give Isordil orally or sublingually. 19. C Eating in the upright position aids in emptying the esophagus. Doing the opposite of the other three also may be helpful. 20. C Pancreatitis involves activation of pancreatic enzymes, such as amylase and lipase. These levels are elevated in a patient with acute pancreatitis. 21. D The normal range of specific gravity of urine is 1.010 to 1.025; a value of 1.030 may be seen with dehydration. 22. C Teach the pt to avoid activities that increase intra-abdominal pressure such as coughing, sneezing, or straining with a bowel movement. 23. C Because obesity weakens the abdominal muscles, advise weight loss for the patient who has had a hernia repair. 24. B After a liver biopsy, the patient is placed on the right side to compress the liver and to reduce the risk of bleeding or bile leakage. 25. A Signs and Symptoms of pneumothorax include dyspnea and decreased or absent breath sounds over the affected lung (right lung). 26. A An NG tube is inserted into the patients stomach to drain fluid and gas. 27. A Aspirating the stomach contents confirms correct placement. If an X-ray is ordered, it should be done immediately, not in 24 hours. 28. B TPN is given I.V. to provide all the nutrients your patient needs. TPN isn’t a tube feeding nor is it a liquid dietary supplement. 29. A Type A causes changes in parietal cells. 30. B Increasing fluids helps empty the stomach. A high carb diet isn’t restricted and fat intake shouldn’t be increased. 31. A Diarrhea d/t an acute episode of ulcerative colitis leads to fluid & electrolyte losses so fluid replacement takes priority. 32. D Sigmoidoscopy allows direct observation of the colon mucosa for changes, and if needed, biopsy. 33. C She needs a high-fiber diet and a psyllium (bulk laxative) to promote normal soft stools. 34. B Stools from ulcerative colitis are often bloody and contain mucus. 35. D One sign of acute diverticulitis is crampy lower left quadrant pain. A low-grade fever is another common sign. 36. C With acute pancreatitis, you need to rest the GI tract by TPN as nutritional support. 37. A The gallbladder is located in the RUQ and a frequent sign of gallstones is pain radiating to the shoulder. 38. D A Jackson-Pratt drain promotes wound healing by allowing fluid to escape from the wound. 39. D After creation of a colostomy, expect to see a stoma that is pink, slightly edematous, with some oozing. Bright red blood, regardless of amount, indicates bleeding and should be reported to the doctor. 40. A Only a small amount of skin should be exposed and more than 1/16” of skin allows the excretement to irritate the skin. 41. B Measuring abdominal girth provides quantitative information about increases or decreases in the amount of distention. 42. C Because the GI tract is functioning, feeding methods involve the enteral route which bypasses the mouth but allows for a major portion of the GI tract to be used. 43. B The first step in assessing the abdomen is to observe its shape and contour, then auscultate, palpate, and then percuss. 44. B Lowering the height decreases the amount of flow, allowing him to tolerate more fluid. 45. D Pancrelipase provides the exocrine pancreatic enzyme necessary for proper protein, fat, and carb digestion. With increased fat digestion and absorption, stools become less frequent and normal in appearance. 46. B Glucose level increases and diabetes mellitus may result d/t the pancreatic damage to the islets of langerhans. 47. D After surgery, she remains NPO until peristaltic activity returns. This decreases the risk for abdominal distention and obstruction. 48. D A brownish-black color indicates lack of blood flow, and maybe necrosis. 49. A Restricting fluids decrease the amount of body fluid and the accumulation of fluid in the peritoneal space. 50. D Dark green, leafy vegetables are rich in calcium. 51. A For pruritus, care should include tepid sponge baths and use of emollient creams and lotions. 52. D Rest periods and small frequent meals is indicated during the acute phase of hepatitis B. 53. D Hepatitis B can recur. Patients who have had hepatitis are permanently barred from donating blood. Alcohol is metabolized by the liver and should be avoided by those who have or had hepatitis B. 54. A To prevent venous stasis and improve muscle tone, circulation, and respiratory function, encourage her to move after surgery. 55. A Telling her not to worry minimizes her feelings. 56. A Diazepam is absorbed by the plastic I.V. tubing and should be given in the port closest to the vein. 57. A For the first few days to a week, slight bleeding normally occurs when the stoma is touched because the surgical site is still new. She should report profuse bleeding immediately. 58. D To wash away tissue debris and drainage effectively, irrigate the wound until the solution becomes clear or all the solution is used. 59. A Ammonia levels increase d/t improper shunting of blood, causing ammonia to enter systemic circulation, which carries it to the brain. 60. D Saline solution is isotonic, or close to body fluids in content, and is used along with sterile dressings to cover an eviscerated wound and keep it moist. 61. B Crohn’s disease penetrates the mucosa of the colon through all layers and destroys the colon in patches, which creates a cobblestone appearance. 62. A Stomach pain is often a late sign of stomach cancer; outcomes are particularly poor when the cancer reaches that point. Surgery, chemotherapy, and radiation have minimal positive effects. TPN may enhance the growth of the cancer. 63. C Melena is the passage of dark, tarry stools that contain a large amount of digested blood. It occurs with bleeding from the upper GI tract. 64. A A patient with an acute upper GI hemorrhage must be treated for hypovolemia and hemorrhagic shock. You as a nurse can’t diagnose the problem. Controlling the bleeding may require surgery or intensive medical treatment. 65. D To stabilize a patient with acute bleeding, NS or LR solution is given I.V. until BP rises and urine output returns to 30ml/hr. 66. A Initially, you should assess the patient’s knowledge about colostomies and how it will affect his lifestyle. 67. B An inflammatory condition that affects the surface of the colon, ulcerative colitis causes friability and erosions with bleeding. Patients with ulcerative colitis are at increased risk for bowel perforation, toxic megacolon, hemorrhage, cancer, and other anorectal and systemic complications. 68. C Medications to control inflammation such as corticosteroids are used for long-term treatment. 69. A Meats and beans are high-protein foods. In liver failure, the liver is unable to metabolize protein adequately, causing protein by-products to build up in the body rather than be excreted. 70. B A gastric residual greater than 2 hours worth of feeding or 100-150ml is considered too high. The feeding should be stopped; NG tube clamped, and then allow time for the stomach to empty before additional feeding is added. 71. C Frequent mouth care helps relieve dry mouth. 72. C Coffee-ground emesis occurs when there is upper GI bleeding that has undergone gastric digestion. For blood to appear as coffee-ground emesis, it would have to be digested for approximately 2 hours. 73. C Normally, drainage is bloody for the first 24 hours after a partial gastrectomy; then it changes to brown-tinged and then to yellow or clear. 74. D If the vagus nerve is cut as it enters the stomach, gastric acid secretion is decreased, but intestinal motility is also decreased and gastric emptying is delayed. Because gastric acids are decreased, gastric pH increases. 75. A Dosage problem. It’s 80/20 = 240/X. X=60. 76. A The output from an Ileostomy is described. 77. B As healing occurs from the bile duct, bile drains from the tube; the amount of bile should decrease. Teach the patient to expect dark green drainage and to notify the doctor if drainage stops. 78. C Misoprostol restores prostaglandins that protect the stomach from NSAIDS, which diminish the prostaglandins. 79. C 80. D Is experiencing an acute episode of ulcerative colitis which is the priority for this patient?Acute severe ulcerative colitis as defined by Truelove Witt's criteria is a medical emergency that requires immediate hospitalization. Fluid and electrolyte balance, withdrawl of drugs promoting colonic dilatation and adequate nutritional support are important adjuncts in the management of severe UC.
What is considered severe ulcerative colitis?Ulcerative Colitis Diagnosis
You have severe disease if you experience six or more bowel movements per day. Your doctor is especially looking to see if the frequency of bowel movements increases during an attack. Your doctor will also order blood tests to help confirm a diagnosis.
Which test should the nurse expect to be ordered for a client suspected of having diverticulosis?Abdominal and Pelvic CT: A CT scan is the best test to diagnose diverticulitis. It can also help determine the severity of the condition and guide treatment. You may receive an intravenous (IV) injection of contrast material. You may also drink an oral contrast material one hour before your scan.
Which of the following factors is believed to cause ulcerative colitis?Abnormal immune response, genetics, microbiome, and environmental factors all contribute to ulcerative colitis. Research suggests that ulcerative colitis could be triggered by an interaction between a virus or bacterial infection in the colon and the body's immune response.
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