Following administration of a dose of metoclopramide (Reglan) to the patient, the nurse determines

that the medication has been effective when what is noted?

A. Decreased blood pressure

B. Absence of muscle tremors

C. Relief of nausea and vomiting

D. No further episodes of diarrhea C. Relief of nausea and vomiting

Metoclopramide is classified as a prokinetic and antiemetic medication. If it is effective, the patient's

nausea and vomiting should resolve. Metoclopramide does not affect blood pressure, muscle tremors,
or diarrhea.

The patient receiving chemotherapy rings the call bell and reports the onset of nausea. The nurse should
prepare an as-needed dose of which medication?

A. Morphine sulfate

B. Zolpidem (Ambien)

C. Ondansetron (Zofran)

D. Dexamethasone (Decadron) Ondansetron is a 5-HT3 receptor antagonist antiemetic that is especially

effective in reducing cancer chemotherapy-induced nausea and vomiting. Morphine sulfate may cause
nausea and vomiting. Zolpidem does not relieve nausea and vomiting. Dexamethasone is usually used in
combination with ondansetron for acute and chemotherapy-induced emesis.

The patient who is admitted with a diagnosis of diverticulitis and a history of irritable bowel disease and
gastroesophageal reflux disease (GERD) has received a dose of Mylanta 30 mL PO. The nurse should
evaluate its effectiveness by questioning the patient as to whether which symptom has been resolved?

A. Diarrhea

B. Heartburn

C. Constipation

D. Lower abdominal pain B. Heartburn

Mylanta is an antacid that contains both aluminum and magnesium. It is indicated for the relief of GI
discomfort, such as heartburn associated with GERD. Mylanta can cause both diarrhea and constipation
as a side effect. Mylanta does not affect lower abdominal pain.
A patient complains of nausea. When administering a dose of metoclopramide (Reglan), the nurse
should teach the patient to report which potential adverse effect?

A. Tremors

B. Constipation

C. Double vision

D. Numbness in fingers and toes A. Tremors

Extrapyramidal side effects, including tremors and tardive dyskinesias, may occur as a result of
metoclopramide (Reglan) administration. Constipation, double vision, and numbness in fingers and toes
are not adverse effects of metoclopramide.

After administering a dose of promethazine (Phenergan) to a patient with nausea and vomiting, what
common temporary adverse effect of the medication does the nurse explain may be experienced?

A. Tinnitus

B. Drowsiness

C. Reduced hearing

D. Sensation of falling B. Drowsiness

Although being given to this patient as an antiemetic, promethazine also has sedative and amnesic
properties. For this reason, the patient is likely to experience drowsiness as an adverse effect of the
medication. Tinnitus, reduced hearing, and loss of balance are not side effects of promethazine.

The nurse determines that a patient has experienced the beneficial effects of therapy with famotidine
(Pepcid) when which symptom is relieved?

A. Nausea

B. Belching

C. Epigastric pain

D. Difficulty swallowing C. Epigastric pain

Famotidine is an H2-receptor antagonist that inhibits parietal cell output of HCl acid and minimizes
damage to gastric mucosa related to hyperacidity, thus relieving epigastric pain. Famotidine is not
indicated for nausea, belching, and dysphagia.

A patient reports having a dry mouth and asks for something to drink. The nurse recognizes that this
symptom can most likely be attributed to a common adverse effect of which medication that the patient
is taking?

A. Digoxin (Lanoxin)

B. Cefotetan (Cefotan)

C. Famotidine (Pepcid)

D. Promethazine (Phenergan) D. Promethazine (Phenergan)

A common adverse effect of promethazine, an antihistamine/antiemetic agent, is dry mouth; another is

blurred vision. Common side effects of digoxin are yellow halos and bradycardia. Common side effects
of cefotetan are nausea, vomiting, stomach pain, and diarrhea. Common side effects of famotidine are
headache, abdominal pain, constipation, or diarrhea.

A patient with a history of peptic ulcer disease has presented to the emergency department reporting
severe abdominal pain and has a rigid, boardlike abdomen that prompts the health care team to suspect
a perforated ulcer. What intervention should the nurse anticipate?

A. Providing IV fluids and inserting a nasogastric (NG) tube

B. Administering oral bicarbonate and testing the patient's gastric pH level

C. Performing a fecal occult blood test and administering IV calcium gluconate

D. Starting parenteral nutrition and placing the patient in a high-Fowler's position A. Providing IV
fluids and inserting a nasogastric (NG) tube

A perforated peptic ulcer requires IV replacement of fluid losses and continued gastric aspiration by NG
tube. Nothing is given by mouth, and gastric pH testing is not a priority. Calcium gluconate is not a
medication directly relevant to the patient's suspected diagnosis, and parenteral nutrition is not a
priority in the short term.

A female patient has a sliding hiatal hernia. What nursing interventions will prevent the symptoms of
heartburn and dyspepsia that she is experiencing?

A. Keep the patient NPO.

B. Put the bed in the Trendelenberg position.

C. Have the patient eat 4 to 6 smaller meals each day.

D. Give various antacids to determine which one works for the patient. C. Have the patient eat 4 to 6
smaller meals each day.

Eating smaller meals during the day will decrease the gastric pressure and the symptoms of hiatal
hernia. Keeping the patient NPO or in a Trendelenberg position are not safe or realistic for a long period
of time for any patient. Varying antacids will only be done with the care provider's prescription, so this is
not a nursing intervention.

A 72-year-old patient was admitted with epigastric pain due to a gastric ulcer. Which patient assessment
warrants an urgent change in the nursing plan of care?

A. Chest pain relieved with eating or drinking water

B. Back pain 3 or 4 hours after eating a meal

C. Burning epigastric pain 90 minutes after breakfast

D. Rigid abdomen and vomiting following indigestion D. Rigid abdomen and vomiting following
indigestion

A rigid abdomen with vomiting in a patient who has a gastric ulcer indicates a perforation of the ulcer,
especially if the manifestations of perforation appear suddenly. Midepigastric pain is relieved by eating,
drinking water, or antacids with duodenal ulcers, not gastric ulcers. Back pain 3-4 hours after a meal is
more likely to occur with a duodenal ulcer. Burning epigastric pain 1-2 hours after a meal is an expected
manifestation of a gastric ulcer related to increased gastric secretions and does not cause an urgent
change in the nursing plan of care.

The patient with chronic gastritis is being put on a combination of medications to eradicate H. pylori.
Which drugs does the nurse know will probably be used for this patient?

A. Antibiotic(s), antacid, and corticosteroid

B. Antibiotic(s), aspirin, and antiulcer/protectant

C. Antibiotic(s), proton pump inhibitor, and bismuth

D. Antibiotic(s) and nonsteroidal antiinflammatory drugs (NSAIDs) C. Antibiotic(s), proton pump

inhibitor, and bismuth
To eradicate H. pylori, a combination of antibiotics, a proton pump inhibitor, and possibly bismuth (for
quadruple therapy) will be used. Corticosteroids, aspirin, and NSAIDs are drugs that can cause gastritis
and do not affect H. pylori.

The nurse should administer an as-needed dose of magnesium hydroxide (MOM) after noting what
information while reviewing a patient's medical record?

A. Abdominal pain and bloating

B. No bowel movement for 3 days

C. A decrease in appetite by 50% over 24 hours

D. Muscle tremors and other signs of hypomagnesemia B. No bowel movement for 3 days

MOM is an osmotic laxative that produces a soft, semisolid stool usually within 15 minutes to 3 hours.
This medication would benefit the patient who has not had a bowel movement for 3 days. MOM would
not be given for abdominal pain and bloating, decreased appetite, or signs of hypomagnesemia.

The nurse is preparing to administer a dose of bisacodyl (Dulcolax). In explaining the medication to the
patient, the nurse would explain that it acts in what way?

A. Increases bulk in the stool

B. Lubricates the intestinal tract to soften feces

C. Increases fluid retention in the intestinal tract

D. Increases peristalsis by stimulating nerves in the colon wall D. Increases peristalsis by stimulating
nerves in the colon wall

Bisacodyl is a stimulant laxative that aids in producing a bowel movement by irritating the colon wall
and stimulating enteric nerves. It is available in oral and suppository forms. Fiber and bulk forming drugs
increase bulk in the stool; water and stool softeners soften feces, and saline and osmotic solutions cause
fluid retention in the intestinal tract.

What should the nurse instruct the patient to do to best enhance the effectiveness of a daily dose of
docusate sodium (Colace)?

A. Take a dose of mineral oil at the same time.

B. Add extra salt to food on at least one meal tray.

C. Ensure dietary intake of 10 g of fiber each day.

D. Take each dose with a full glass of water or other liquid. D. Take each dose with a full glass of
water or other liquid.

Docusate lowers the surface tension of stool, permitting water and fats to penetrate and soften the
stool for easier passage. The patient should take the dose with a full glass of water and should increase
overall fluid intake, if able, to enhance effectiveness of the medication. Dietary fiber intake should be a
minimum of 20 g daily to prevent constipation. Mineral oil and extra salt are not recommended.

The nurse would question the use of which cathartic agent in a patient with renal insufficiency?

A. Bisacodyl (Dulcolax)

B. Lubiprostone (Amitiza)

C. Cascara sagrada (Senekot)

D. Magnesium hydroxide (Milk of Magnesia) D. Magnesium hydroxide (Milk of Magnesia)

Milk of Magnesia may cause hypermagnesemia in patients with renal insufficiency. The nurse should
question this order with the health care provider. Bisacodyl, lubiprostone, and cascara sagrada are safe
to use in patients with renal insufficiency as long as the patient is not currently dehydrated.

The nurse is caring for a 68-year-old patient admitted with abdominal pain, nausea, and vomiting. The
patient has an abdominal mass, and a bowel obstruction is suspected. The nurse auscultating the
abdomen listens for which type of bowel sounds that are consistent with the patient's clinical picture?

A. Low-pitched and rumbling above the area of obstruction

B. High-pitched and hypoactive below the area of obstruction

C. Low-pitched and hyperactive below the area of obstruction

D. High-pitched and hyperactive above the area of obstruction D. High-pitched and hyperactive above
the area of obstruction

Early in intestinal obstruction, the patient's bowel sounds are hyperactive and high-pitched, sometimes
referred to as "tinkling" above the level of the obstruction. This occurs because peristaltic action
increases to "push past" the area of obstruction. As the obstruction becomes complete, bowel sounds
decrease and finally become absent.

The nurse is planning care for a 68-year-old patient with an abdominal mass and suspected bowel
obstruction. Which factor in the patient's history increases the patient's risk for colorectal cancer?
A. Osteoarthritis

B. History of colorectal polyps

C. History of lactose intolerance

D. Use of herbs as dietary supplements B. History of colorectal polyps

A history of colorectal polyps places this patient at risk for colorectal cancer. This tissue can degenerate
over time and become malignant. Osteoarthritis, lactose intolerance, and the use of herbs do not pose
additional risk to the patient.

A 61-year-old patient with suspected bowel obstruction had a nasogastric tube inserted at 4:00 AM. The
nurse shares in the morning report that the day shift staff should check the tube for patency at what
times?

A. 7:00 AM, 10:00 AM, and 1:00 PM

B. 8:00 AM, 12:00 PM, and 4:00 PM

C. 9:00 AM and 3:00 PM

D. 9:00 AM, 12:00 PM, and 3:00 PM B. 8:00 AM, 12:00 PM, and 4:00 PM

A nasogastric tube should be checked for patency routinely at 4-hour intervals. Thus if the tube were
inserted at 4:00 AM, it would be due to be checked at 8:00 AM, 12:00 PM, and 4:00 PM.

What information would have the highest priority to be included in preoperative teaching for a 68-year-
old patient scheduled for a colectomy?

A. How to care for the wound

B. How to deep breathe and cough

C. The location and care of drains after surgery

D. Which medications will be used during surgery B. How to deep breathe and cough

Because anesthesia, an abdominal incision, and pain can impair the patient's respiratory status in the
postoperative period, it is of high priority to teach the patient to cough and deep breathe. Otherwise,
the patient could develop atelectasis and pneumonia, which would delay early recovery from surgery
and hospital discharge. Care for the wound and location and care of the drains will be briefly discussed
preoperatively, but done again with higher priority after surgery. Knowing which drugs will be used
during surgery may not be meaningful to the patient and should be reviewed with the patient by the
anesthesiologist.

Two days following a colectomy for an abdominal mass, a patient reports gas pains and abdominal
distention. The nurse plans care for the patient based on the knowledge that the symptoms are
occurring as a result of

A. impaired peristalsis.

B. irritation of the bowel.

C. nasogastric suctioning.

D. inflammation of the incision site. A. impaired peristalsis.

Until peristalsis returns to normal following anesthesia, the patient may experience slowed
gastrointestinal motility leading to gas pains and abdominal distention. Irritation of the bowel,
nasogastric suctioning, and inflammation of the surgical site do not cause gas pains or abdominal
distention.

Following bowel resection, a patient has a nasogastric (NG) tube to suction, but complains of nausea and
abdominal distention. The nurse irrigates the tube as necessary as ordered, but the irrigating fluid does
not return. What should be the priority action by the nurse?

A. Notify the physician.

B. Auscultate for bowel sounds.

C. Reposition the tube and check for placement.

D. Remove the tube and replace it with a new one. C. Reposition the tube and check for placement.

The tube may be resting against the stomach wall. The first action by the nurse (since this is intestinal
surgery and not gastric surgery) is to reposition the tube and check it again for placement. The physician
does not need to be notified unless the tube function cannot be restored by the nurse. The patient does
not have bowel sounds, which is why the NG tube is in place. The NG tube would not be removed and
replaced unless it was no longer in the stomach or the obstruction of the tube could not be relieved.

The nurse is caring for a postoperative patient with a colostomy. The nurse is preparing to administer a
dose of famotidine (Pepcid) when the patient asks why the medication was ordered since the patient
does not have a history of heartburn or gastroesophageal reflux disease (GERD). What response by the
nurse would be the most appropriate?
A. "This will prevent air from accumulating in the stomach, causing gas pains."

B. "This will prevent the heartburn that occurs as a side effect of general anesthesia."

C. "The stress of surgery is likely to cause stomach bleeding if you do not receive it."

D. "This will reduce the amount of HCl in the stomach until the nasogastric tube is removed and you can
eat a regular diet again." D. "This will reduce the amount of HCl in the stomach until the
nasogastric tube is removed and you can eat a regular diet again."

Famotidine is an H2-receptor antagonist that inhibits gastric HCl secretion and thus minimizes damage
to gastric mucosa while the patient is not eating a regular diet after surgery. Famotidine does not
prevent air from accumulating in the stomach or stop the stomach from bleeding. Heartburn is not a
side effect of general anesthesia.

A stroke patient who primarily uses a wheelchair for mobility has diarrhea with fecal incontinence. What
should the nurse assess first?

A. Fecal impaction

B. Perineal hygiene

C. Dietary fiber intake

D. Antidiarrheal agent use A. Fecal impaction

Patients with limited mobility are at risk for fecal impactions due to constipation that may lead to liquid
stool leaking around the hardened impacted feces, so assessing for fecal impaction is the priority.
Perineal hygiene can be assessed at the same time. Assessing the dietary fiber and fluid intake and
antidiarrheal agent use will be assessed and considered next.

Which clinical manifestations of inflammatory bowel disease are common to both patients with
ulcerative colitis (UC) and Crohn's disease (select all that apply)?

A. Restricted to rectum

B. Strictures are common.

C. Bloody, diarrhea stools

D. Cramping abdominal pain

E. Lesions penetrate intestine. C, D.

Clinical manifestations of UC and Crohn's disease include bloody diarrhea, cramping abdominal pain,
and nutritional disorders. Intestinal lesions associated with UC are usually restricted to the rectum
before moving into the colon. Lesions that penetrate the intestine or cause strictures are characteristic
of Crohn's disease.

After the nurse teaches a patient with gastroesophageal reflux disease (GERD) about recommended
dietary modifications, which statement by the patient indicates that the teaching has been effective?

A. "I can have a glass of low-fat milk at bedtime."

B. "I will have to eliminate all spicy foods from my diet."

C. "I will have to use herbal teas instead of caffeinated drinks."

D. "I should keep something in my stomach all the time to neutralize the excess acids." C. "I will have
to use herbal teas instead of caffeinated drinks."

Rationale: Patients with gastroesophageal reflux disease should avoid foods (such as tea and coffee) that
decrease lower esophageal pressure. Patients should also avoid milk, especially at bedtime, as it
increases gastric acid secretion. Patients may eat spicy foods, unless these foods cause reflux. Small,
frequent meals help prevent overdistention of the stomach, but patients should avoid late evening
meals and nocturnal snacking.

Any imbalance in protective features of the stomach such as mucus, bicarb, blood flow at superficial
level, prostagladins, & the alkaline environment that leads to inflammation will result in which
diagnosis?

A) Gastritis

B) PUD

C) Delayed gastric emptying

D) H. pylori associated PUD A) Gastritis

Which of the follow could cause gastritis?

A) EtOH

B) NSAIDS

C) Helicobacter pylori

D) CNS injury

E) Pernicious anemia
F) All the above F) All the above

If a pt is dx'ed with Type A gastritis where would you find the pathology?

A) Stomach antrum and body

B) Stomach body B) Stomach body

If a pt is dx'ed with Type B gastritis where would you find the pathology?

A) Stomach antrum and body

B) Stomach body A) Stomach antrum and body

Which of the following 2 sx's are common for gastritis?

A) Dyspepsia

B) Anorexia

C) Vomiting

D) Nausea

E) Abdominal pain A & E (dyspepsia and abdominal pain)

Which of the following 3 sx's are less common for gastritis?

A) Dyspepsia

B) Anorexia

C) Vomiting

D) Nausea

E) Abdominal pain B, C & D (nausea, vomiting and diarrhea)

Any break in the mucosa caused by injury due to irritants OR injury caused by precipitants that lead to
the irritating environment describes:

A) Gastritis

B) PUD

C) Delayed gastric emptying

D) H. pylori associated PUD B) PUD

Of the following, which is the MOST common causes of PUD (according to Ms. Hayes)?

A) EtOH

B) NSAIDS

C) Helicobacter pylori
D) CNS injury C) Helicobacter pylori (she said that some people argue that NSAIDS are the MC so i
would remember both)

A 34 y.o. female presents to Urgent Care with a gnawing pain in the mid-epigastrium and LUQ. She
states the pain is a 4/10, but increases to an 8/10 when she eats. She endorses nausea, anorexia and an
unintentional 10 lb weight loss over the past 2 weeks. What are you most concerned for?

A) Gastritis

B) Gastric ulcer

C) Delayed gastric emptying

D) Duodenal ulcer B) Gastric ulcer (key is that these *worsen* with food)

A 34 y.o. female presents to Urgent Care with a gnawing pain in the mid-epigastrium and LUQ. She
states the pain is a 4/10, but increases to an 8/10 when she eats. She endorses nausea, anorexia and an
unintentional 10 lb weight loss over the past 2 weeks. You are concerned for PUD, what is the BEST test
you would do next?

A) Barium swallow

B) CT Abdomen

C) Endoscopy with biopsy C) Endoscopy with biopsy (this would be the best test because you can
r/o malignancy which we would be concerned about d/t the weight loss and anorexia and/or prove H.
pylori; you can do a barium swallow but it's less sensitive and there are more false negatives)

A 38 y.o. male presents to Urgent care c/o a gnawing pain in the RUQ that radiates through to the back.
States pain is rated at a 7/10, but improves to a 3/10 with eating. Pt also endorses mild nausea, a
sensation of being full and a recent onset of melena. Denies any fevers, weight changes, chest pain or
other sx's. What are you most concerned for?

A) Gastritis

B) Gastric ulcer

C) Delayed gastric emptying

D) Duodenal ulcer D) Duodenal ulcer (key is that these *improve* with food)

Which of the following is NOT an offending agent that increases incidence of gastritis or ulcers?

A) Smoking

B) NSAIDS

C) EtOH

D) Excessively acidic environment A) Smoking (smoking irritates EXISTING ulcers, but doesn't
necessarily increase chance of developing ulcers or gastritis)
Pt comes in c/o epigastric/LUQ abdominal pain, nausea, anorexia, and weight loss. You do a full work up
including an endoscopy. You r/o malignancy, but there was no proven H. pylori. Thus you think the
cause of the pt's PUD is NSAIDS. How would you treat this pt?

A) Initiate PPI

B) D/c NSAIDS

C) Increase the alkaline environment of the stomach

D) A & C

E) A & B E) A & B (stop the offending agent i.e. the NSAID and start a PPI if needed)

T/F: About 60% of pt's who have H. pylori infection will develop gastric cancer. False (other way
around; 60% of gastric cancer pts have had H. pylori infection)

T/F: H. pylori is a gram negative spiral shaped bacillus True

Which of the following is an appropriate test to diagnose H. pylori associated PUD?

A) Urea breath tests

B) Mucosal biopsy

C) Serum antibody

D) Stool antigen

E) All the above E) All the above

Which of the following diagnostic tests for H. pylori associated PUD is unhelpful in determining if a
patient is currently infected?

A) Urea breath tests

B) Mucosal biopsy

C) Serum antibody

D) Stool antigenC) Serum antibody

When treating H. pylori associated PUD you Rx PPI with Clarythromycin and Amoxicillin for how many
days?

A) 7 days

B) 14 days

C) 21 days

D) 28 days B) 14 days (PCN allergic PPI and bismuth subsalicylate with tetracycline and
metronidazole)

Which of the following tests can you perform to prove eradication of H. pylori associated PUD?
A) Urea breath tests

B) Mucosal biopsy

C) Serum antibody

D) Stool antigenD) Stool antigen

T/F: Misoprostol is a prophylactic therapy for H. pylori associated PUD True (use this for NSAID,
steroid, or anticoagulant-required pts; also pts with h/o complicated bleeds)

A pt with altered gastric motility would have which of the following?

A) Gastritis

B) Gastric ulcer

C) Delayed gastric emptying

D) Duodenal ulcer C) Delayed gastric emptying

Which of the following does NOT cause delayed gastric emptying?

A) Smooth muscle abnormality

B) Neurologic dysfunction

C) H. pylori

D) Diabetic-induced gastroparesis C) H. pylori

Which of the following treatments would be most appropriate for a pt with delayed gastric emptying?

A) PPI

B) H2 Blocker

C) Antacid

D) Prokinetic agents D) Prokinetic agents (to encourage movement and emptying because it
promotes movement)

A 62 y.o. female presents with non-radiating epigastric abdominal pain and fatigue. She reports that for
the past 3 days she has also had diarrhea. You start with lab work and the pt has a low hemoglobin and
and elevated gastrin. This raises your suspicion for which of the following?

A) Adenocarcinoma

B) Carcinoid

C) Zollinger-Ellison Syndrome (ZES)

D) MALT Lymphoma C) Zollinger-Ellison Syndrome (ZES) (this syndrome is caused by the gastrin
secreting tumors called gastrinomas)
Which of the following 2 things would be appropriate treatment for a pt with Zollinger-Ellison Syndrome
(ZES)?

A) Surgical resection (if possible)

B) Chemo/rads

C) PPI A & C (surgical resection when you can and a PPI)

T/F: A secretin test is a confirmatory test for Zollinger-Ellison Syndrome (ZES) True (can also do
Endoscopy, CT, or MRI to localize the gastrinomas)

Which of the following is among the most common global cancers?

A) Adenocarcinoma

B) Carcinoid

C) Gastrinoma A) Adenocarcinoma

A 68 y.o. male presents with epigastric pain, nausea, and vomiting after eating. He also endorses
anorexia and a 15 lb unintentional weight loss. On PE you noted a palpable mass in the left
supraclavicular region. Pt has a positive hemoccult and low hemoglobin; normal gastrin. This raises your
suspicion for which of the following?

A) Adenocarcinoma

B) Carcinoid

C) Zollinger-Ellison Syndrome (ZES)

D) MALT Lymphoma A) Adenocarcinoma

Which of the following is NOT a sign of metastasis of adenocarcinoma?

A) Virchow's node

B) Sister Mary Joseph Nodule

C) Axillary node C) Axillary node

Which of the following 2 things would be appropriate treatment for a pt with adenocarcinoma?

A) Surgical resection (if possible)

B) Chemo/rads

C) PPI A & B (surgical resection (this may be curative or palliative) and chemo/rads (may provide
palliative benefit))

This neoplasm of the stomach is typically benign, self limiting, but can cause issues with the appendix.

A) Adenocarcinoma

B) Carcinoid
C) Zollinger-Ellison Syndrome (ZES)

D) MALT Lymphoma B) Carcinoid

Which of the following is an uncommon gastric malignancy and it's risk is increased by an active H. pylori
infection.

A) Adenocarcinoma

B) Carcinoid

C) Zollinger-Ellison Syndrome (ZES)

D) MALT Lymphoma D) MALT Lymphoma

T/F: The stomach is MC extranodal site for Non-Hodgkins lymphoma True

Which of the following 2 things would be appropriate treatment for a pt with MALT lymphoma ?

A) Surgical resection (if possible)

B) Chemo/rads

C) PPI A & B (surgical resection and chemo/rads)

T/F: The w/u for adenocarcinoma and MALT lymphoma would include Iron studies, LFTs, EGD for pts >40
with refractory symptoms and CT for TNM classification and staging True

GI BLEEDING

The most frequent cause of upper gastrointestinal (UGI) bleeding is? Peptic ulcer disease

A 73-year-old man presents with several episodes of hematemesis. Examination shows signs of
orthostatic hypotension and melena. What is the first priority in caring for this patient?

A: Nasogastric (NG) tube placement and gastric lavage

B: Resuscitation with adequate intravenous (IV) access and appropriate fluid and blood product fusion

C: IV infusion of H2-receptor antagonists (H2RAs) to stop the bleeding

D: Urgent upper panendoscopy

E: Urgent surgical consultation B. Resuscitation with adequate intravenous (IV) access and appropriate
fluid and blood product fusion

For the patient who is now stable after a severe UGI bleed associated with NSAID ingestion, and who is
found to be H. pylori positive, what is the most effective management strategy?

A: Stop NSAIDs, eradicate H. pylori, daily proton pump inhibitor (PPI) maintenance therapy
B: Stop NSAIDs, daily PPI maintenance therapy

C: Stop NSAIDs

D: Eradicate H. pylori, daily PPI maintenance therapy

E: Daily PPI maintenance therapy A: Stop NSAIDs, eradicate H. pylori, daily proton pump inhibitor
(PPI) maintenance therapy

A 66-year-old man presents to the emergency department with a history of one episode of hematemesis
and melena. Past history includes coronary artery disease, hypertension, and abdominal aortic
aneurysm repair. He is on one baby aspirin daily. An urgent upper endoscopy is negative. What is the
most appropriate next step?

A: UGI series with small bowel follow-through

B: Colonoscopy

C: Angiography

D: Red blood cell tagged technetium scan

E: Abdominal CT scan with contrast E: Abdominal CT scan with contrast

A 58-year-old woman presents to the emergency department with a 24-hour history of several bloody
bowel movements. She denies any abdominal pain but complains of light headedness. She is found to be
hypotensive and anemic. Resuscitative measures are instituted. What is the most appropriate next step?

A: NG tube placement

B: Anoscopic examination

C: Colonoscopic examination

D: Scintigraphy

E: Angiography A: NG tube placement

You are treating an 80 you male in whom you suspect a lower GI bleed. Which of these following
statements is TRUE regarding the guaiac test?

A. A false positive may be caused by ingestion of magnesium-containing antacids

B. A false negative may be caused by the presence of chlorophyll

C. A false positive may be caused by the presence of methylene blue

D. A false negative may be caused by the presence of bromide preparations The answer is C. Red
fruits or meats, methylene blue, chlorophyll, iodide, cupric sulfate and bromide preparations can cause a
false positive guaiac test. A false negative guaiac test can be caused by bile or ingestion of magnesium-
containing antacids or ascorbic acid. Red Jell-O, tomato sauce, wine, iron therapy and Pepto-Bismol may
cause the stool to look bloody when it is not.

A 20 year old man presents to the emergency department with 1 week of intermittent bloody bowel
movements associated with crampy abdominal pain, tenesmus, and fecal urgency. He is previously
healthy. He is not on medications; nor has he recently traveled. What test will most likely confirm his
diagnosis?

A. a workup for a bleeding diathesis

B. colonoscopy to rule out inflammatory bowel disease

C. barium enema to rule out intussusception

D. stool culture to rule out invasive bacterial diarrhea The answer is B. This patient will need a
colonoscopy with intestinal biopsy to evaluate for inflammatory bowel disease such as ulcerative colitis
and Crohn's disease or other causes of colitis. Appendicitis usually presents with periumbilical pain
migrating to the right lower quadrant with associated anorexia, not bloody bowel movements.
Intussusception is uncommon after the age of 6. A stool culture should be obtained to rule out bacterial
colitis, but his history is less suggestive of this.

An 85 year old woman presents with acute lower abdominal pain and bloody diarrhea for 1 day. On
exam her abdomen is slightly distended with diffuse tenderness. Her vital signs are stable. A plain film X-
ray shows "thumbprinting" suggesting the diagnosis of:

A. Volvulus

B. Intussusception

C. Invasive gastroenteritis

D. Ischemic colitis The answer is D. Thumbprinting represents local areas of swelling in the bowel
mucosa caused by submucosal edema and hemorrhage and suggests ischemic colitis.

The most common cause of intrinsic lower gastrointestinal (GI) bleeding in an adult is:

A. Polyps

B. Inflammatory bowel disease

C. Diverticulosis

D. Cancer The answer is C. Diverticulosis and angiodysplasia account for 80% of lower GI bleeds. In
approximately 10% of all patients with GI bleeding, no source of bleeding will be found.

Regarding gastrointestinal bleeding, which of the following is TRUE?

A. The majority of bleeding from diverticula occurs from the right side of the colon

B. The most common cause of upper gastrointestinal bleeding in both adults and children is peptic ulcer
disease

C. The mortality of lower gastrointestinal bleeding is higher than the mortality of upper gastrointestinal
bleeding

D. Patients with a history of gastrointestinal bleeding almost always bleed again from the same site
The answer is A. There are many specific etiologies that cause gastrointestinal bleeding. In
general, however, the mortality of upper gastrointestinal bleeding is higher than lower gastrointestinal
bleeding. In adults, the most common cause of upper gastrointestinal bleeding is peptic ulcer disease. In
children, it is esophagitis. Unfortunately, it can be difficult to diagnose the source of gastrointestinal
bleeding as the bleeding may often stop and start spontaneously or from different sites.

The most common cause of adult upper gastrointestinal (GI) bleeding is:

A. Varices

B. Peptic ulcer disease (PUD)

C. Mallory-Weiss tears

D. Esophagitis The answer is B. The most common causes of upper GI bleeding are (in descending
order of frequency): PUD, gastric erosions, varices, Mallory-Weiss tears, esophagitis, and duodenitis.

A 67 year old man with a history of peptic ulcer disease presents to the emergency department
complaining of feeling light-headed. On ROS he acknowledges having had black tarry stools for the past
2-3 days. On exam he is noted to be pale with the following vital signs: T 97.3 F, HR 126, BP 92/64, RR
22, and melena is noted on rectal exam. Which of the following is an INCORRECT recommendation
regarding the initial management of this patient?

A. Type and cross two units of packed red blood cells.

B. Place two intravenous lines that are 22-gauge.

C. Place the patient on cardiac and oxygen saturation monitors.

D. Apply supplemental oxygen.

E. Administer normal saline intravenously in 10mg/kg boluses. The answer is B. The patient is having
gastrointestinal bleeding most likely from a peptic ulcer given his history. Urgent first steps in
management include placement of two intravenous lines that are larger-bore than 22-gauge (18 gauge
or larger size preferred) to enable rapid volume resuscitation, in addition to the oxygen, monitoring,
intravenous fluids and preparation of blood products. Patients with an upper GI bleed who remain
hemodynamically unstable require urgent consultation with gastroenterology.
The most common cause of lower GI bleeding is:

A. Angiodysplasia

B. Cancer

C. Peptic ulcer disease

D. Esophageal varices

E. Diverticulosis The answer is E. Diverticulosis is the most common cause of lower GI bleeding.
Angiodysplasia is the more common in young people.

A 49 year old presents complaining of 1 day of painful bright red blood per rectum. He has painful bowel
movements and streaks of blood appear on the toilet paper. He has had hard stools for two weeks after
starting opiate pain medication for a broken arm. He has never had these symptoms before. Based on
the patient's history, the physician examining the patient will likely find:

A. An internal hemorrhoid

B. A nonthrombosed external hemorrhoid

C. An anal fissure

D. A thrombosed external hemorrhoid The answer is C. Sudden sharp pain after defecation along with
blood on toilet tissue characterizes anal fissures. A thrombosed external hemorrhoid causes painful
bleeding on defecation. Usually there is a history of external hemorrhoids and associated itching,
swelling, and mucoid drainage. Internal hemorrhoids usually exhibit painless bleeding that may drip into
the toilet after defecation. Rectal cancers also have painless bleeding but usually are associated with a
change in bowel movement character and other signs and symptoms of malignancy.

Which of the following bacteria does NOT produce bloody diarrhea?

A. Yersinia enterocolitica

B. Clostridium perfringens

C. Campylobacter enteritis

D. Escherichia coli 0157 The answer is B. Clostridium perfringens is the most common cause of food
poisoning in the United States. Patients ingest heat-resistant spores of C. pergringens which produce an
enterotoxin in the GI tract. Campylobacter, E. coli 0157, Salmonella and Yersinia are all invasive bacteria
that can cause bloody enteritis.

PUD, CROHNS, UC

In planning care for the patient with Crohn's disease, the nurse recognizes that a major difference
between ulcerative colitis and Crohn's disease is that Crohn's disease: (Source: Medical-Surgical
Nursing, LHD pg. 1055) A. frequently results in toxic megacolon, B. causes fewer nutritional
deficiencies than does ulcerative colitis, C. often recurs after surgery, whereas ulcerative colitis is
curable with a colectomy, D. is manifested by rectal bleeding and anemia more frequently than is
ulcerative colitis. Answer C, often recurs after surgery, whereas ulcerative colitis is curable with
a colectomyRationale: Because there is a high recurrence rate after surgical treatment of Crohn's
disease, medications are the preferred treatment.

In planning the care for the patient with Crohn's disease, the nurse recognizes that a major difference
between ulcerative colitis and Crohn's disease is that Crohn's disease: a) frequently results in toxic
megacolon b) causes fewer nutritional deficiencies than does ulcerative colitis. c) often recurs after
surgery, whereas ulcerative colitis is curable with a colectomy. d) is manifested by rectal bleeding and
anemia more frequently than is ulcerative colitis. CORRECT ANSWER: CBecause there is a high
recurrence rate after surgical treatment of Crohn's disease, medications are the preferred treatment.

"Which associated disorder might a client with ulcerative colitis exhibit "1. Gallstone 2. Hyronephrosis

3.Nephrolithiasis 3. Toxic megacolon Answer 3, Toxic megacolon is extreme dilation of a segemnt of

the diseased colon caused by paralysis of the colon

What is one of the major precipitating factors in the development of irritable bowel syndrome (IBS)?
"A. Stress

B. Peptic ulcers

C. GERD

D.Helicobacter pylori" Answer A: Stress, Rationale: Stress is one of the major factors for developing
irritable bowel syndrome (IBS), along with dietary factors.

The nurse is reviewing the record of a female client with Crohn's disease. Which stool characteristics
should the nurse expect to note documented in the client's record 1. Diarrhea 2. Chronic constipation
3. Constipation alternating with diarrhea 4. Stools constantly oozing form the rectum Answer 1:
Diarrhea, Crohn's disease is characterized by nonbloody diarrhea and around 4-5 stools per day. Over
time, episodes of diarrhea increase in frequency, duration, and severity.

The client is diagnosed with Crohn's disease, also known as regional enteritis. Which statement by the
client would support this diagnosis? 1. "My pain goes away when I have a bowel movement" 2. "I
have bright red blood in my stool all the time" 3. "I have episodes of diarrhea and constipation" 4.
"My abdomen is hard and rigid and I have a fever". 1. (CORRECT) The terminal ileum is the most
common site for regional enteritis and causes right lower quadrant pain that is relieved by defecation
2. Stools are liquid or semi-formed and usually do not contain blood 3. Episodes of diarrhea and
constipation may be a sign/symptom of colon cancer, not Crohn'sdisease 4. A fever and hard rigid
abdomen are signs/symptoms of peritonitis, a complication of Crohn's disease

Which associated disorder might a client with Crohn's disease exhibit most often? 1. Ankylosing
spondylitis 2. Colon cancer 3. Malabsorption 4. Lactase deficiency Answer 3; Malabsorption
Because of the transmural nature of Crohn's disease lesions, malabsorption may occur with Crohn's
disease. Although ankylosing spondylitis and colon cancer are more commonly associated with
ulcerative colitis, they may be seen in clients with Crohn's disease, Lactase deficiency is caused by a
congenital defect in which an enzyme isn't present.
Nurse is caring for a patient with a diagnosis of ulcerative colitis. Which finding, if noted on
assessment of the client, would the nurse report to the Dr? A. Hypotension B. Bloody diarrhea C.
Rebound tenderness D. Hemoglobin of 12 mg/ dl C. Rebound tenderness because this could
indicate peritonitis.

A client with acute colcerative colitis requests a snack. Which of the following foods is the most
appropriate to give the client? A. Carrots and ranch dip B. Whole grain cereal and milk C. A cup of
popcorn and a cola D. Applesauce and a graham cracker D, appelsauce and graham cracker, The
diet for a client with ulcerative coliits should be a low-fiber, low residue diet. The nurse should avoid
foods such as whole grains, nuts and fresh fruit or vegetables. Typically lactose containing foods are
also poorly tolerated. The client should also avoid caffeine, pepper, and alcohol.

The client is diagnosed with an acute exacerbation of ulcerative colitis. Which intervention should the
nurse implement? 1. Provide a low-residue diet. 2. Monitor intravenous fluids. 3. Assess vital signs
daily. 4. Administer antacids orally. 1. The client's bowel should be placed on rest and no foods or
fluids should be introduced into the bowel. 2. (CORRECT) The client requires fluids to help prevent
dehydration from diarrheh and to replace fluid lost through normal body functioning. 3. The vital
signs must be taken more often than daily in a client who is having an acute exacerbation of ulcerative
colitis. 4. The client will receive anti-inflammatory and antidiarrheal medications, not antacids, which
are used for gastroenteritis.

The client is diagnosed with Crohn's disease, also known as regional enteritis. Which statement by the
client would support this diagnosis? 1. "My pain goes away when I have a bowel movement." 2."I
have bright red blood in my stool all the time." 3."I have episodes of diarrhea and constipation."
4."My abdomen is hard and rigid and I have a fever." Correct answer: #1 pain goes away w/ BM, The
terminal ileum is the most common site for regional enteritis and causes right lower quadrant pain
that is relieved by defecation.

The nurse is reviewing the record of a client with Chron's disease. Which stool characteristic should
the nurse expect to note documented in the client's record? 1. Diarrhea 2. Chronic constipation 3.
Constipation alternating with diarrhea 4. Stool constantly oozing from teh rectum Diarrhea,
Crohn's disease is characterized by nonbloody diarrhea of usually not more than four to five stools
daily. Over time, the diarrhea episodes increase in frequency, duration, and severity. Options 2, 3, and
4 are not characteristics of Crohn's disease.

"In planning care for the patient with crohns disease the

nurse recognizes that a major difference between UC

and Crohn's disease is that:

1. Frequently results in toxic megacolon 2. causes fewer

nutritional deficiencies than does UC 3. Often recurs

after surgery whereas UC is curable with a colectomy

4. is manifested by rectal bleeding and

anemia more frequently than UC" Answer 3, "Medication is the primary treatment for Crohn's
disease"

A client is admitted with irritable bowel syndrome. The nurse would anticipate the client's history to
reflect which of the following? 1. Pattern of alternating diarrhea and constipation. 2. Chronic diarrhea
stools occurring 10-12 times per day. 3. Diarrhea and vomiting with severe abdominal distention. 4.
Bloody stools with increased cramping after eating. Think about each answer choice. (1) correct-
condition is often called spastic bowel disease; no inflammation is present (2) refers to inflammatory
bowel disease such as ulcerative colitis or Crohn's disease (3) refers to inflammatory bowel disease
such as ulcerative colitis or Crohn's disease (4) bloody stools do not occur 38.

The nurse is caring for a hospitalized female client with a diagnosis of ulcerative colitis. Which finding,
if noted on assessment of the client, would the nurse report to the physician? "a. Hypotension

b. Bloody diarrhea

c. Rebound tenderness

d. A hemoglobin level of 12 mg/dL" Answer C. Rebound tenderness may indicate peritonitis.

Bloody diarrhea is expected to occur in ulcerative colitis. Because of the blood loss, the client may be
hypotensive and the hemoglobin level may be lower than normal. Signs of peritonitis must be
reported to the physician.

"The nurse is teaching the client about gastritis. Which

of the following statements by the nurse would be more

accurate in describing gastritis? 1. Erosion of the gastric mucosa

2. Inflammation of a diverticulum

3. Inflammation of the gastric mucosa

4. Reflux of stomach acid into the esophagus" "3. Gastritis is an inflammation of the gastric

mucosa that may be accute (often resulting from

exposure to local irritants) or chronic (associated

w/ autoimmune infections or atrophic disorders of

the somach). Erosion of the mucosa results in

ulceration. Inflammation of the diverticulum is

called diverticulitis; reflux of stomach acid is

known as gastroesophageal reflux disease."

"Which sign/symptom should the nurse

expect to find in a client diagnosed with ulcerative colitis?

1. Twenty bloody stools a day. 2.

Oral temperature of 102 F̊ . 3. Hard, rigid abdomen.

4. Urinary stress incontinence." Answer = 1. The colon is ulcerated and unable to absorb water,
resulting in bloody diar- rhea. Ten (10) to 20 bloody diarrhea stools is the most common symptom of
ulcerative colitis.

2. Inflammation usually causes an elevated temperature but is not expected in the client with
ulcerative colitis.

3.A hard, rigid abdomen indicates peritonitis, which is a complication of ulcerative colitis but not an
expected symptom.

4. Stress incontinence is not a symptom of colitis."

The nurse is caring for a client diagnosed with ulcerative colitis. Which symptom(s) support this
diagnosis? 1. Increased appetite and thirst 2. Elevated hemoglobin 3. Multiple bloody, liquid stools. 4.
Exacerbations unrelated to stress Answer 3: Clients report as many as 10 to 20 liquid bloody
stools in a day.

The nurse is reviewing the record of a client with Crohn's disease. Which stool characteristic should
the nurse expect to note documented in the client's record? 1. Diarrhea 2. Chronic constipation 3.
Constipation alternating with diarrhea 4. Stool constantly oozing from the rectum Diarrhea,
Rationale: Crohn's disease is characterized by nonbloody diarrhea of usually not more than four to
five stools daily. Over time, the diarrhea episodes increase in frequency, duration and severity.
Options 2, 3 and 4 are not characteristics of Crohn's diease.

The nurse prepares for the admission of a client with a perforated duodenal ulcer. Which of the
following should the nurse expect to observe as the primary initial symptom? 1. Fever 2. Pain 3.
Dizziness 4. Vomiting 2, Pain: 1. Fever - later with peritonitis (S/S: pain, nausea, vomiting, rigid
abdomen, low-grade fever, absent bowel sounds, shallow respirations). 2. Pain - CORRECT: sudden,
sharp, begins mid-epigastric; boardlike abdomen. 3. Dizziness - later with shock (S/S: hypotension,
tachycardia, tachypnea, decreases urinary output, decrased LOC). 4. Vomiting - seen with peritonitis

The client diagnosed with Crohn's disease is crying and tells the nurse, "I can't take itanymore. I never
know when I will get sick and end up here in the hospital." Whichstatement would be the nurse's best
response? 1."I understand how frustrating this must be for you."2."You must keep thinking about the
good things in your life." 3. "I can see you are very upset. I'll sit down and we can talk."4."Are you
thinking about doing anything like committing suicide?" Answer 3, I can see you are very upset,
I'll sit down and we can talk, "1.The nurse should never tell a client that they understand what they
are going through.2.This is not addressing the client's feelings.

3. (Correct answer) The client is crying and is expressing feel-ings of powerlessness; therefore the
nurseshould allow the client to talk.

4.The client is crying and states "I can't take itanymore," but this is not a suicidal commentor
situation."

The client is diagnosed with Crohn's disease, also known as regional enteritis. Which statement by the
client supports this diagnosis? 1. "My pain goes away when I have a bowel movement." 2. "I have
bright red blood in my stool all the time." 3. "I have episodes of diarrhea and constipation." 4. "My
abdomen is hard and rigid and I have a fever." 1. "My pain goes away when I have a bowel
movement, 1. (correct) The terminal ileum is the most common site for regional enteritis, which
causes right lower quandrant pain that is relieved by defecation. 2. Stools are liquid or semiformed
and do not contain blood. 3. Episodes of diarrhea and constipation may be a sign/symptom of colon
cancer, not Crohn's disease. 4. A fever and hard rigid abdomen are signs/symptoms of peritonitis, a
complication of Crohn's disease.

Following bowel resection, a patient has a nasogastric tube to suction, but complains of nausea and
abdominal distention. The nurse irrigates the tube prn as ordered, but the irrigating fluid does not
return. Which of the following should be the priority action by the nurse? A. Notify the physician B.
Auscultate for bowel sounds. C. Reposition the tube and check for placement. D. Remove the tube
and replace it with a new one. C, reposition the tube and check for placementThe tube may be
resting against the stomach wall. The first action by the nurse, since this was intestinal surgery (not
gastric surgery), is to reposition the tube and check it again for placement.

"Older patients with longstanding or severe Crohn's disease can exhibit which of the following?

a Hyperalbuminemia b)Hypoalbuminemia c) Decreased sedimentation rate d)Nausea and vomiting

Hypoalbuminemia, Rationale wasn't given for this question but Crohns affects the GI tract
which will affect the ability to absorb protein so it is lost through the urine.

The nurse is caring for a male client postoperatively following creation of a colostomy. Which nursing
diagnosis should the nurse include in the plan of care? -1) a. sexual dysfunction b. body image,
disturbed c. fear related to poor prognosis d. Nutrition: more than body requirements, imbalanced
Answer B. Body image, disturbed relates to loss of bowel control, the presence of a stoma, the
release of fecal material onto the abdomen, the passage of flatus, odor, and the need for an appliance
(external pouch). No data in the question support options A and C. Nutrition: less than body
requirements, imbalanced is the more likely nursing diagnosis.

18. The client is diagnosed with an acute exacerbation of IBD. Which priority intervention should the
nurse implement first? "1. Weigh the client daily and document it in the client's chart.

2. Teach coping strategies such as dietary modifications.

3. Record the frequency, amount, and color of stools.

4. Monitor the client's oral fluid intake every shift." Answer 3, Record the frequency, amount, and
color of stools"Rationale by answer option: 1. Weighing the client daily will help identify if

the client is experiencing malnutrition, but it is

not the priority intervention during an acute

exacerbation.

2. Coping strategies help develop healthy ways to

deal with this chronic disease that has remissions

and exacerbations, but it is not the priority

intervention.

3. The severity of the diarrhea helps determine

the need for fluid replacement. The

liquid stool should be measured as part of

the total output. (CORRECT)

4. The client will be NPO when there is an acute

exacerbation of IBD to allow the bowel to rest."

During the assessment of a patient with acute abdominal pain, the nurse should: a. perform deep
palpation before ausculation b. obtain BP and pulse rateto determine hypervolemic changes c.
auscultate bowel sounds because hyperactive bowel sounds suggest paralytic ileus d. measure body
temperature because and elevated temperature may indicate an inflammatory or infectious process.
Answer D, If the temperature is elevated pain may be due to infection.

A patient returns to his room following a lower GI series. When he is assessed by the nurse, he
complains of weakness. Which of the following nursing diagnoses should receive priority in planning
his care? 1. Alteration in sensation - gustatory 2. Constipation, colonic 3. High risk for fluid volume
deficit 4. Nutrition, less than body requirements Answer 3, high risk for fluid vol. deficitprep for
test: low-residue or clear liquid diet 2 days, NPO midnight, enemas, laxatives, post-test: laxatives to
remove barium

The client is diagnosed with an acute exacerbation of ulcerative colitis. Which intervention should the
nurse implement? 1.Provide a low-residue diet.2.Monitor intravenous fluids.3.Assess vital signs
daily.4.Administer antacids orally. 2. The client requires fluid to prevent dehydration from
diarrhea and to replace fluid lost through normal body functioning.

A client with inflammatory bowel disease is receiving TPN (total parenteral nutrition) via an infusion
pump. When administering TPN it is essential that the nurse: A. monitor the clients blood glucose
level Q2H at the bedside with a glucometer B. change the TPN solution bag every 24 hours even if
there is solution left in the bag C. instruct the client to breathe shallowly when changing the TPN
tubing using sterile technique D. speed up the rate of the TPN infusion if the amount delivered has
fallen behind the prescribed hourly rate B. TPN solutions are high in glucose and are
administered at room temperature, factors that increase the risk of microbial growth in the solution.
They should be changed daily or sooner if they appear cloudy.

A client with Crohn's disease is admitted to the hospital with a history of chronic, bloody diarrhea,
weight loss, and signs of general malnutrition. The client has anemia, a low serum albumin level, and
signs of negative nitrogen balance. The nurse concludes that the client's health status is related to a
major deficiency of: 1. Iron 2. Protein 3. Vitamin C 4. Linoleic acid CORRECT ANSWER 2: Protein
deficiency causes a low serum albumin level, which permits fluid shifts from the intravascular to the
interstitial compartment, resulting in edema. Decreased protein also causes anemia; protein intake
must be increased. Although a deficiency of iron will result in anemia, it will not cause the other
adaptations. Vitamin C and linoleic acid are unrelated to these adaptations.
The nurse is teaching a female client how to perform a colostomy irrigation. To enhance the
effectiveness of the irrigation and fecal returns, what measure would the nurse tell the client to do?
"a. Increase fluid intake

b. Place heat on the abdomen

c. Perform the irrigation in the evening

d. Reduce the amount of irrigation solution" Answer A. To enhance effectiveness of the irrigation
and fecal returns, the client is instructed to increase fluid intake and to take other measures to
prevent constipation. Options B, C and D will not enhance the effectiveness of this procedure.

Which diagnostic test is used first to evaluate a client with upper GI bleeding? "a) Hemoglobin levels
and hematocrit (HCT)

b) Endoscopy

c) Arteriography

d) Upper GI series Correct Answer: (A) Hgb and Hct levels"

Hemoglobin and HCT are typically performed first in clients with upper GI bleeding to evaluate the
extent of blood loss. Endoscopy is then performed to directly visualize the upper GI tract and locate
the source of bleeding. An upper GI series, or barium study, usually isn't the diagnostic method of
choice, especially in a client with acute active bleeding who's vomiting and unstable. An upper GI
series is also less accurate than endoscopy. Although an upper GI series might confirm the presence of
a lesion, it wouldn't necessarily reveal whether the lesion is bleeding. Arteriography is an invasive
study associated with life-threatening complications and wouldn't be used for an initial evaluation.

The nurse is assigning clients for the evening shift. Which of the following clients are appropriate for
the nurse to assign to a licensed practical nurse to provide client care? Select all that apply. "1. A
client with Crohn's disease who is

receiving total parenteral nutrition (TPN).

2. A client who underwent inguinal hernia repair surgery 3 hours ago.

3. A client with an intestinal obstruction who needs a Cantor

tube inserted.

4. A client with diverticulitis who needs teaching about his

take-home medications.

5. A client who is experiencing an exacerbation of his

ulcerative colitis." "2,5

The nurse should consider client needs

and scope of practice when assigning staff to provide care. The client who is
recovering from inguinal hernia repair surgery and the client who is

experiencing an exacerbation of his ulcerative colitis are appropriate clients

to assign to a licensed practical nurse as the care they require fall within

the scope of practice for a licensed practical nurse. It is not within the

scope of practice for the licensed practical nurse to administer TPN, insert

nasoenteric tubes, or provide client teaching related to medications."

THe nurse is caring for a client with a diagnosis of Crohn's disease. When evaluating a clients response
to healthcare intervention, which expected outcome is the most important for the client: A. does
skincare B. takes oral fluids C. gains .5 lb per week D. experiences less abdominal cramping Answer
C = gains .5lbs/wk, weight loss usually is severe with Crohn's disease, therefore, weight gain is a
priority. this goal is specific, realistic, measureable and has a timeframe.

A client with inflammatory bowel disease (IBD) requires an ileostomy. The nurse would instruct the
client to do which of the following measures as an essential part of caring for the stoma? 1.Perform
massage of the stoma three times a day. 2.Include high-fiber foods in the diet, especially nuts. 3.Limit
fluid intake to prevent loose stools. 4.Cleanse the peristomal skin meticulously. 4; cleanse
peristomal skin meticulously1.It is not an intervention used for ileostomies. 2.Clients should avoid the
high-fiber and gas-producing foods. 3.These clients are not on fluid restriction. 4.Careful cleansing is
necessary to prevent skin breakdown and skin irritation.

Older patients with longstanding or severe Crohn's disease can exhibit which of the following? A.
Hyperalbumineria B. Hypoalbumenria C. Decreased Sedimentation Rate (ESR) D. Nausea and Vomiting
B, hypoalbumenriaThey may be seen with conditions in which the body does not properly
absorb and digest protein, such as Crohn's disease or celiac disease, or in which large volumes of
protein are lost from the intestines.

A client who has a history of Crohn's disease is admitted to the hospital with fever, diarrhea,
cramping, abdominal pain, and weight loss. The nurse should monitor the client for: ) 1.
Hyperalbuminemia. 2. Thrombocytopenia. (3.) Hypokalemia. 4. Hypercalcemia. Hypokalemia is
the most expected laboratory finding owing to the diarrhea. Hypoalbuminemia can also occur in
Crohn's disease; however, the client's potassium level is of greater importance at this time because a
low potassium level can cause cardiac arrest. Anemia is an expected development, but
thrombocytopenia is not. Calcium levels are not affected.

"The client is diagnosed with Crohn's disease, also known as regional enteritis. Whichstatement by
the client would support this diagnosis?

(1)."My pain goes away when I have a bowel movement."2."I have bright red blood in my stool all the
time."3."I have episodes of diarrhea and constipation."4."My abdomen is hard and rigid and I have a
fever." "(1).The terminal ileum is the most common site for regional enteritis and causes right lower
quadrant pain that is relieved by defecation.
2.Stools are liquid or semi-formed and usually do not contain blood.3.Episodes of diarrhea and
constipation may be asign/symptom of colon cancer, not Crohn'sdisease.4.A fever and hard rigid
abdomen are signs/symptoms of peritonitis, a complication of Crohn's disease."

"Which of the following would be the highest priority information to include in preoperative teaching
for a 68-year old patient scheduled for a colectomy?

"A. how to care for the wound

(B). how to deep breath and cough

C. the location and care of drains after surgery

D. what medications will be used during surgery" Because anasthesia, an abdominal incision,
and pain can impair the patient's respiratory status in the postoperative period, it is of high priority to
teach the pt. to cough and deep breathe. Otherwise, the pt. could develop atelectasis and pneumonia,
which would delay early recovery from surgery and hospital discharge.

"The results of a patient's recent endoscopy indicate the presence of peptic ulcer disease (PUD).
Which of the following teaching points should the nurse provide to the patient in light of his new
diagnosis?

"A. "You'll need to drink at least two to three glasses of milk daily."

B. "It would likely be beneficial for you to eliminate drinking alcohol."

C. "Many people find that a minced or pureed diet eases their symptoms of PUD."

D. "Your medications should allow you to maintain your present diet while minimizing symptoms.""
"Although there is no specific recommended dietary modification for PUD,

most patients find it necessary to make some sort of dietary

modifications to minimize symptoms. Milk may exacerbate PUD and alcohol

is best avoided because it can delay healing."

In planning care for a patient with ulcerative colitis, the nurse should anticipate which of the following
diagnostic procedures? a. sigmoidodscopy b. colonoscopy, c. rectal mucosa biopsy, d. all of the above
Diagnosis of ulcerative colitis is confirmed with the use of sigmoidoscopy, colonoscopy, and
rectal mucosa biopsy.

The nurse performs a detailed assessment of the abdomen of a patient with a possible bowel
obstruction, knowing that a manifestion of an obstruction in the large intestine is (select all that
apply) a ) a largely distended abdomen b) diarrhea that is loose or liquid c) persistent, colickcy
abdominal pain d) profuse vomiting that relieves abdominal pain. A & C: distended abd + colicky
abd painPersistent, colicky abdominal pain is seen with lower intestinal obstruction. Abdominal
distention is markedly incerased in lower interestinal obstructions. Onset of a large intestine
obstruction is gradual, vomiting is rare, and there is usually absolute constipation.
The client with inflammatory bowel disease had surgery to create a continent kock's ileostomy
yesterday. The client refuses to look at the stoma when the nurse is teaching stoma care. The best
nursing intervention for the nurse to take is to: "A. notify the physician that the patient is depressed.

B. continue patient teaching to meet care goals.

C. encourage the client to verbalize feelings related to the stoma.

D. offer the client a mirror so they can examine the stoma later when they wish to do so." C,
encourage to talk about feelingsRationale: Clients who have a stoma often experience alterations in
body image. The nurse should encourage the client to verbalize feelings related to disease process and
stoma

A client who has a history of chronic ulcertaive colitis is diagnosed with anemia. The nurse intreprets
that which factor is most likely responxible for the anemia? a. Blood Loss b. Intestinal hookworm c.
intestinal malaborption d. Decreased intake of dietary iron Blood loss, The client with chronic
ulcerative colitis is most likely enemic as a result of chronic blood loss in small amounts tha occurs
with exacerbations of the disease. These clients often have bloody stools and are at increasd risk for
anemia. There is no information in the question to supprot options b. or d. In ulcerative colitis, the
large intestine is involves, not the small intestine, where vitamin B12 and folic acid are absorbed
(option c.)

"Which goal for the client's care should take priority during the first days of hospitalization for an
exacerbation of ulcerative colitis?

source: "A:promoting self care and independence

B:managing diarrhea

C:maintaining adequate nutrition

D:promoting rest and comfort" "B. managing diarrhea

Diarrhea is the primary symptom in an exacerbation of ulcerative colitis, and decreasing the frequency
of stools is the first goal of treatment. The other goals are ongoing and will be best achieved by
haulting the exacerbation. The client may recieve antidiarrheal agents, antispasmodic agents, bulk
hydrophilic agents, or anti-inflammatory drugs."

The nurse is preparing for discharge of a client who recieved a colectomy 4 days earlier. Which of the
following nursing care goals has the highest priority prior to discharge?"A: Lung are clear per
auscultation

B: incision is healed without redness or drainage

C: bowel sounds present, client expels flatus

D: vital signs within normal limits" The correct answer is C because a collectomy involved the GI
tract, the return of normal GI function is most important; the nurse assures the client is expelling gas
prior to discharge.
A client who has had ulcerative colitis for the past 5 years is admitted to the hospital with an
exacerbation of the disease. Which of the following factors was most likely of greatest significance in
causing an exacerbation of ulcerative colitis? 1. A demanding and stressful job. 2. Changing to a
modified vegetarian diet 3. Beginning a weight-training program 4. Walking 2 miles every day C,
Stressful and emotional events have been clearly linked to exacerbations of ulcerative colitis,
although their role in the etiology of the disease has been disproved. A modified vegetarian diet or an
exercise program is an unlikely cause of the exacerbation

When planning care for a client with ulcerative colitis who is experiencing an exacerbation of
symptoms, which client care activities can the nurse appropriately delegate to an unlicensed
assistant? Select all that apply. / 1. Assessing the client's bowel sounds. 2. Providing skin care
following bowel movements.3. Evaluating the client's response to antidiarrheal medications. 4.
Maintaining intake and output records. 5. Obtaining the client's weight. (2,4, & 5 are
CORRECT)The nurse can delegate the following basic care activities to the unlicensed assistant:
providing skin care following bowel movements, maintaining intake and output records, and
obtaining the client's weight. Assessing the client's bowel sounds and evaluating the client's response
to medication are registered nurse activities that cannot be delegated.

Which of the following would be the highest priority information to include in preoperative teaching
for a 68-year-old patient scheduled for a colectomy? "A: How to care for the wound

B: How to deep breathe and cough

C: The location and care of drains after surgery

D: What medications will be used during surgery" B: How to deep breathe and coughBecause
anesthesia, an abdominal incision, and pain can impair the patient's respiratory status in the
postoperative period, it is of high priority to teach the patient to cough and deep breathe. Otherwise,
the patient could develop atelectasis and pneumonia, which would delay early recovery from surgery
and hospital discharge.

"Treatment of Crohn's disease?

"1. Diet

2. Vitamins

3. Medications

4. Surgery

5. All of thee above "A low residue diet is recommend

low fiber diet

vitamins and iron suplements are recommended

Surgery is an option and helps to relieve symptoms

(lecture)"
The client diagnosed with IBD is prescribed TPN. Which nursing intervention should the nurse
implement? (Med-Surg Success, 2nd Edition, Davies Q&A Success Series) 1, Check the patients glucose
level 2. Administer and oral hypoglycemic 3. Access the peripheral IV site. 4. Monitor the client's oral
food intake 1, Check patient's glucose level

The nurse cares for a client receiving a balanced completed food by tube. The nurse knows the MOST
common complication of a tube feeding is which of the following? "1: Edema

2: Diarrhea

3: Hypokalemia

4: Vomiting" 2, diarrhea

A patient with a history of peptic ulcer disease has presented to the emergency department with
complaints of severe abdominal pain and a rigid, boardlike abdomen, prompting the health care team
to suspect a perforated ulcer. Which of the following actions should the nurse anticipate? a. Providing
IV fluids and inserting a nasogastric tube; b. Administering oral bicarbonate and testing the patient's
gastric pH level; c. Performing a fecal occult blood test and administering IV calcium gluconate; d.
Starting parenteral nutrition and placing the patient in a high-Fowler's position; A, IV fluids +
NG tubeA perforated peptic ulcer requires IV replacement of fluid losses and continued gastric
aspiration by NG tube. Nothing is given by mouth and gastric pH testing is not a priority. Calcium
gluconate is not a medication directly relevant to the patient's suspected diagnosis and parenteral
nutrition is not a priority in the short term

"A client is admitted

with inflammatory bowel syndrome (Crohn's disease). Which treatment measures

should the nurse expect to be part of the care plan?

SELECT ALL THAT APPLY!

"1) Laculose therapy

2) High fiber diet

3) High protein milkshakes

4) Corticosteroid therapy

5) Antidiarrheal medications 4) Corticosteroid therapy

5) Antidiarrheal medications

"Which of the following diets would be most appropriate for the client with ulcerative colitis?

1. High-calorie, low-protein.

2. High-protein, low-residue.

3. Low-fat, high-fiber.

4. Low-sodium, high-carbohydrate." "2. High protein, low residue

Clients with ulcerative colitis should follow a well-balanced high-protein, high-calorie, low-residue
diet, avoiding such high-residue foods as whole-wheat grains, nuts, and raw fruits and vegetables.
Clients with ulcerative colitis need more protein for tissue healing and should avoid excess roughage.
There is no need for clients with ulcerative colitis to follow low-sodium diets."

"The nurse is teaching about irritable bowel syndrome. Which of the following would be most
important?

"A. Reinforcing the need for a balanced diet

B. Encouraging the client to drink 16 ounces of fluid with each meal

C. Telling the client to eat a diet low in fiber

D. Instructing the client to limit his intake of fruits and vegetables" A, reinforce the need for
balanced dietThe nurse should reinforce the need for a diet balanced in all nutrients and fiber. Foods
that often cause diarrhea and bloating associated with irritable bowel syndrome include fried foods,
caffeinated beverages, alcohol, and spicy foods. Therefore, answers B, C, and D are incorrect.

"The most common surgical procedures for patients with ulcerative colitis are:

1.Subtotal colectomy and ileostomy.

2.Colostomy and ileo-conduit.

3.Laparoscopic gastrectomy.

4.Segmental resection or Rationale: Surgery might be necessary for functional older patients
with acute disease when drug therapy fails and when multiple precancerous lesions are detected. The
most common surgical procedures are subtotal colectomy and ileostomy.

"The nurse explains to the patient with gastoesophageal reflux disease that this disorder

"a. result in acid erosion and ulceration of the esophagus caused by frequent vomiting.

b. will require surgical wrapping or repair of the pyloric sphincter to control the symptoms.

c. is the protrusion of a portion of the stomach into the esophagus through an opening in the
diaphragm.
D. often involves relaxation of the lower esophageal sphincter, allowing stomach contents to back up
into the esophagus "4. Correct answer: d

Rationale: Gastroesophageal reflux disease (GERD) results when the defenses of the esophagus are
overwhelmed by the reflux of acidic gastric contents into the lower esophagus. An incompetent lower
esophageal sphincter (LES) is a common cause of gastric reflux."

What is the first line Tx of IBD exacerbation? IV steriods

corticosteriods/methylprednisolone

Antibiotics

True or False

You can take Toradol IV for as long as you need to manage pain for IBD? FALSE

Can only give for 72hrs b/c it causes renal failure

then give Tylenol

GERD

Which of the following instructions should the nurse include in the teaching plan for a client who is
experiencing gastroesophageal reflux disease (GERD)?

1. Limit caffeine intake to two cups of coffee per day

2. Do not lie down for 2 hours after eating

3. Follow a low-protein diet

4. Take medications with milk to decrease irritation 2. The nurse should instruct the client to not lie
down for about 2 hours after eating to prevent reflux.

The client is scheduled to have an upper GI tract series of x-rays. Following the x-rays, the nurse
should instruct the client to:

1. Take a laxative

2. follow a clear liquid diet

3. Administer an enema

4. Take an antiemetic 1. The client should take a laxative after an upper GI series to stimulate a
bowel movement. This examination involves the administration of barium, which must be promptly
eliminated from the body because it may harden and cause an obstruction.

A client who has been diagnosed with GERD has heartburn. To decrease the heartburn, the nurse
should instruct the client to eliminate which of the following items from the diet?

1. Lean beef

2. Air-popped popcorn
3. Hot chocolate

4. Raw vegetables 3. With GERD, eating substances that decrease lower esophageal sphincter
pressure causes heartburn. A decrease in the lower esophageal sphincter pressure allows gastric
contents to reflux into the lower end of the esophagus. Foods that can cause a decrease in esophageal
sphincter pressure include fatty foods, chocolate, caffeinated beverages, peppermint, and alcohol.

The client with GERD has a chronic cough. This symptom may be indicative of which of the following?

1. Development of laryngeal cancer

2. Irritation of the esophagus

3. Esophageal scar tissue formation

4. Aspiration of gastric contents 4. Clients with GERD can develop pulmonary symptoms such
as coughing, wheezing, and dyspnea, that are caused by the aspiration of gastric contents.

Bethanechol (Urecholine) has been prescribed for a client with GERD. The nurse should assess the
client for which of the following adverse effects?

1. Constipation

2. Urinary urgency

3. Hypertension

4. Dry oral mucosa 2. This is a cholinergic drug that may be used in GERD to increase lower
esophageal sphincter pressure and facilitate gastric emptying. Cholinergic adverse effects may include
urinary urgency, diarrhea, abdominal cramping, hypotension, and increased salivation.

The client attends two sessions with the dietitian to learn about diet modifications to minimize GERD.
The teaching would be considered successful if the client decreases the intake of which of the
following foods?

1. fats

2. high-sodium foods

3. Carbohydrates

4. high calcium foods 1. Fats are associated with decreased esophageal sphincter tone.

Which of the following dietary measures would be useful in preventing Esophageal reflux?

1. Eating small, frequent meals

2. increasing fluid intake

3. avoiding air swallowing with meals

4. Adding a bedtime snack to the dietary plan 1. Esophageal reflux worsens when the stomach is
over-distended with food. Therefore, an important measure is to eat small,frequent meals.
The nurse is obtaining a health history from a client who has a sliding hiatal hernia associated with
reflux. The nurse should ask the client about the presence of which of the following symptoms?

1. Heartburn

2. Jaundice

3. Anorexia

4. Stomatitis 1. Heartburn, the most common symptom of a sliding hiatal hernia , results from
reflux of gastric secretions into the esophagus. Regurgitation of gastric contents and dysphagia are
other common symptoms.

Which of the following factors would most likely contribute to the development of a client's hiatal
hernia?

1. having a sedentary desk job

2. being 5 feet, 3 inches tall and weighing 190 lbs

3. using laxatives frequently

4. being 40 years old 2. Any factor that increases intra-abdominal pressure, such as obesity, can
contribute to the development of hiatal hernia. Other factors include abdominal straining, frequent
heavy lifting, and pregnancy. Hiatal hernia is also associated with older age and occurs in women
more frequently than in men.

Which of the following nursing interventions would most likely promote self-care behaviors in the
client with a hiatal hernia?

1. Introduce the client to other people who are successfully managing their care.

2. Include the client's daughter in the teaching so that she can help implement the plan

3. Ask the client to identify other situation in which the client changed health care habits

4. Provide reassurance that the client will be able to implement all aspects of the plan successfully.
3. self-responsibility is the key to individual health maintenance. Using examples of situation
in which the client has demonstrated self-responsibility can be reinforcing and supporting. The client
has ultimate responsibility for personal health habits.

The client has been taking magnesium hydroxide (milk of magnesia) to control hiatal hernia
symptoms. The nurse should assess the client for which of the following conditions most commonly
associated with the ongoing use of magnesium based antacids?

1. anorexia

2. weight gain

3. diarrhea

4. constipation 3. The magnesium salts in magnesium hydroxide are related to those found in
laxatives and may cause diarrhea.
Which of the following lifestyle modifications should the nurse encourage the client with hiatal hernia
to include in ADLs?

1. Daily aerobic exercise

2. eliminating smoking and alcohol use

3. balancing activity and rest

4. avoiding high-stress situation 2. Smoking and alcohol use both reduce esophageal sphincter
tone and can result in reflux. They therefore should be avoided by clients with hiatal hernia.

In developing a teaching plan for the client with a hiatal hernia, the nurses assessment of which work-
related factors would be most useful?

1. number and length of breaks

2. body mechanics used in lifting

3. temperature in the work area

4. Cleansing solvents used 2. Bending, especially after eating, can cause GERD. Lifting heavy
objects increases intra-abdominal pressure. Assessing the client's lifting techniques enables the nurse
to evaluate the client's knowledge of factors contributing to hiatal hernia and how to prevent
complications.

The nurse instructs the client on health maintenance activities to help control symptoms from a hiatal
hernia. Which of the following statements would indicate that the client has understood the
instructions?

1. "I'll avoid lying down after a meal."

2. "I can still enjoy my potato chips and cola at bedtime."

3. "I wish I didn't have to give up swimming."

4. "If I wear a girdle, I'll have more support for my stomach." 1. A client with a hiatal hernia should
avoid the recumbent position immediately after meals to minimize gastric reflux. Bedtime snacks, as
well as high fat foods and carbonated beverages should be avoided.

The physician prescribes metoclopramide hyrochloide (Reglan) for the client with a hiatal hernia. This
drug is used in hiatal hernia therapy to accomplish which of the following objectives?

1. Increase tone of the esophageal sphincter

2. Neutralize gastric secretions

3. delay gastric emptying

4. reduce secretion of digestive juices 1. This medicaiton increases esophageal sphincter tone and
facilitates gastric emptying; both actions reduce the incidence of reflux.
The nurse should instruct the client to avoid which of the following drugs while taking
metoclopramide hydrochloride (Reglan)?

1. Antacids

2. Antihypertensives

3. Anticoagulants

4. Alcohol 4. This drug can cause sedation. Alcohol and other CNS depressants add to this
sedation. A client taking this drug should be cautioned to avoid driving or performing other hazardous
activities for a few hours after taking the drug.

A client is taking cemetidine (Tagament) to treat a hiatal herna. The nurse should evaluate the client
to determine that the drug has been effective in preventing which of the following?

1. esophageal reflux

2. dysphagia

3. esophagitis

4. ulcer formation A histamine receptor blocker that decreases the quantity of gastric secretions.
It may be used in hiatal hernia therapy to prevent or treat the esophagitis and heartburn associated
with reflux.

The client asks the nurse if surgery is needed to correct a hiatal hernia. Which reply by the nurse
would be the MOST accurate?

1. "Surgery is usually required, although medical treatment is attempted first."

2. "Hiatal hernia symptoms can usually be successfully managed with diet modification, medications,
and lifestyle changes."

3. "Surgery is not performed for this type of hernia."

4. "A minor surgical procedure to reduce the size of the diaphragmatic opening will probably be
planned." 2. Most clients can be treated successfully with a combination of diet restrictions,
medications, weight control, and lifestyle modifications. Surgery is performed only when these
attempts fail.