During preparation for bowel surgery,
a male client receives an antibiotic to
reduce intestinal bacteria. Antibiotic
therapy may interfere with the
synthesis of which vitamin and may
lead to hypoprothrombinemia?
When evaluating a male client for complications
of acute pancreatitis, the nurse would observe
for:
A male client with a recent history of rectal
bleeding is being prepared for a colonoscopy.
How should the nurse position the client for this
test initially?
A male client with extreme weakness, pallor,
weak peripheral pulses, and disorientation is
admitted to the emergency department. His wife
reports that he has been “spitting up blood.” A
Mallory-Weiss tear is suspected, and the nurse
begins taking the client’s history from the client’s
wife. The question by the nurse that
demonstrates her understanding of Mallory-
Weiss tearing is:
Which of the following nursing interventions
Answer: Vitamin K
Answer: Decreased urine output
R: Acute pancreatitis can cause decreased urine
output, which results from the renal failure that
sometimes accompanies this condition. AKI
develops late in the course of acute pancreatitis,
usually after failure of other organs. Remarkably,
the kidney was the first organ to fail in only 8.9%
of patients with AKI, and only a minority of
patients develop isolated AKI
Answer: Lying on the left side with knees bent
R: For a colonoscopy, the nurse initially should
position the client on the left side with knees
bent. Preparation for a colonoscopy is the biggest
complaint that most patients have about
receiving the procedure and is a primary reason
for non-compliance to screening colonoscopies.
The technician or nurse is there to assist with
preserving stability and preventing the patient
from rolling forward or backward. Also, they are
there to help provide counter pressure to the
abdomen to assist the endoscopist in navigating
corners and turns.
Answer: “Tell me about your husband’s alcohol
usage.”
R: A Mallory-Weiss tear is associated with
massive bleeding after a tear occurs in the
mucous membrane at the junction of the
esophagus and stomach. There is a strong
relationship between ethanol usage, resultant
vomiting, and a Mallory-Weiss tear. Mallory-
Weiss tears account for an estimated 1-15% of
cases of upper gastrointestinal bleeding.
Although the age range varies widely, affected
individuals are generally in middle age (40s-50s),
and men reportedly have a higher incidence than
women by a ratio of 2-4:1.
Answer: Change the tube feeding solutions and
should the nurse perform for a female client
receiving enteral feedings through a gastrostomy
tube?
A male client is recovering from a small bowel
resection. To relieve pain, the physician
prescribes meperidine (Demerol), 75 mg I.M.
every 4 hours. How soon after administration
should meperidine onset of action occur?
The nurse is caring for a male client with
cirrhosis. Which assessment findings indicate that
the client has deficient vitamin K absorption
caused by this hepatic disease?
Which condition is most likely to have a nursing
diagnosis of fluid volume deficit?
While a female client is being prepared for
discharge, the nasogastric (NG) feeding tube
becomes clogged. To remedy this problem and
teach the client’s family how to deal with it at
home, what should the nurse do?
tubing at least every 24 hours
Answer: 15 to 30 minutes
R: Meperidine’s onset of action is 15 to 30
minutes. It peaks between 30 and 60 minutes
and has a duration of action of 2 to 4 hours.
Meperidine is in the class of phenylpiperidine as a
hydrochloride salt synthetic form of the opioid.
Meperidine is used for the treatment of
moderate to severe pain. It has intramuscular,
subcutaneous, intravenous injection, syrup, and
tablet forms.
Answer: Purpura and petechiae
R: A hepatic disorder, such as cirrhosis, may
disrupt the liver’s normal use of vitamin K to
produce prothrombin (a clotting factor).
Consequently, the nurse should monitor the
client for signs of bleeding, including purpura and
petechiae. Petechiae and purpura result from a
wide variety of underlying disorders and may
occur at any age. Petechiae are small (1–3 mm),
red, non-blanching macular lesions caused by
intradermal capillary bleeding. Purpura are
larger, typically raised lesions resulting from
bleeding within the skin.
Answer: Pancreatitis
R: Hypovolemic shock from fluid shifts is a major
factor in acute pancreatitis. The other conditions
are less likely to exhibit fluid volume deficit. Early
fluid therapy is the cornerstone of treatment and
is universally recommended; however, there is a
lack of consensus regarding the type, rate,
amount, and endpoints of fluid replacement. The
basic goal of fluid depletion should be to prevent
or minimize the systemic response to
inflammatory markers.
Answer: Irrigate the tube with warm water
R: The American Society for Parenteral and
Enteral Nutrition (ASPEN) recommends warm
water as the best initial choice for trying to
unclog a feeding tube. First, attach a 30- or 60-mL

A male client with pancreatitis complains of pain.
The nurse expects the physician to prescribe
meperidine (Demerol) instead of morphine to
relieve pain because:
Mandy, an adolescent girl is admitted to an acute
care facility with severe malnutrition. After a
thorough examination, the physician diagnoses
anorexia nervosa. When developing the plan of
care for this client, the nurse is most likely to
include which nursing diagnosis?
Which diagnostic test would be used first to
evaluate a client with upper GI bleeding?
A female client who has just been diagnosed with
hepatitis A asks, “How could I have gotten this
disease?” What is the nurse’s best response?
piston syringe to the feeding tube and pull back
the plunger to help dislodge the clog. Next, fill
the flush syringe with warm water, reattach it to
the tube, and attempt a flush.
Answer: Morphine may cause spasms of Oddi’s
sphincter
R: For a client with pancreatitis, the physician will
probably avoid prescribing morphine because
this drug may trigger spasms of the sphincter of
Oddi (a sphincter at the end of the pancreatic
duct), causing irritation of the pancreas.
Morphine showed an excitatory effect on the
sphincter of Oddi and might be a cause of Oddi’s
sphincter dysfunction (SOD). SO may function as
a peristaltic pump to actively expel fluid from the
sphincter segment into the duodenum.
Answer: Chronic low self-esteem
R: Young women with chronic low self-esteem —
are at the highest risk for anorexia nervosa
because they perceive being thin as a way to
improve their self-confidence. Anorexia nervosa
is an illness of starvation, brought on by severe
disturbance of body image and a morbid fear of
obesity. People with anorexia nervosa attempt to
maintain a weight that’s far below normal for
their age and height.
Answer: Endoscopy
R: Endoscopy permits direct evaluation of the
upper GI tract and can detect 90% of bleeding
lesions. Endoscopy is the insertion of a long, thin
tube directly into the body to observe an internal
organ or tissue in detail. It can also be used to
carry out other tasks including imaging and minor
surgery. Endoscopes are minimally invasive and
can be inserted into the openings of the body
such as the mouth or anus. 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.
Answer: “You may have eaten contaminated
restaurant food.”

When preparing a male client, age 51, for surgery
to treat appendicitis, the nurse formulates a
nursing diagnosis of Risk for infection related to
inflammation, perforation, and surgery. What is
the rationale for choosing this nursing diagnosis?
A female client with hepatitis C develops liver
failure and GI hemorrhage. The blood products
that would most likely bring about hemostasis in
the client are:
To prevent gastroesophageal reflux in a male
client with a hiatal hernia, the nurse should
provide which of the following discharge
instructions?
The nurse caring for a client with small bowel
obstruction would plan to implement which
nursing intervention first?
R: Hepatitis A virus typically is transmitted by the
oral-fecal route — commonly by consuming food
contaminated by infected food handlers. The
hepatitis A virus (HAV) is a common infectious
etiology of acute hepatitis worldwide. HAV is
most commonly transmitted through the oral-
fecal route via exposure to contaminated food,
water, or close physical contact with an infectious
person. The virus isn’t transmitted by the I.V.
route, blood transfusions, or unprotected sex.
Answer: Obstruction of the appendix reduces
arterial flow, leading to ischemia, inflammation,
and rupture of the appendix
R: A client with appendicitis is at risk for infection
related to inflammation, perforation, and surgery
because obstruction of the appendix causes
mucus fluid to build up, increasing pressure in the
appendix and compressing venous outflow
drainage. The pressure continues to rise with
venous obstruction; arterial blood flow then
decreases, leading to ischemia from lack of
perfusion.
Answer: Cryoprecipitate and fresh frozen plasma
R: The liver is vital in the synthesis of clotting
factors, so when it’s diseased or dysfunctional, as
in hepatitis C, bleeding occurs. Treatment
consists of administering blood products that aid
clotting. These include fresh frozen plasma
containing fibrinogen and cryoprecipitate, which
have most of the clotting factors.
Answer: “Avoid coffee and alcoholic beverages.”
R: To prevent reflux of stomach acid into the
esophagus, the nurse should advise the client to
avoid foods and beverages that increase stomach
acids, such as coffee and alcohol. Instruct the
patient regarding avoidance of alcohol, smoking,
and caffeinated beverages. These increase acid
production and may cause esophageal spasms.
Answer: Administering I.V. fluids
R: I.V. infusions containing normal saline solution
and potassium should be given first to maintain
fluid and electrolyte balance. Maintenance of
bowel rest requires alternative fluid replacement

A female client with dysphagia is being prepared
for discharge. Which outcome indicates that the
client is ready for discharge?
A male client undergoes total gastrectomy.
Several hours after surgery, the nurse notes that
the client’s nasogastric (NG) tube has stopped
draining. How should the nurse respond?
What laboratory finding is the primary diagnostic
indicator for pancreatitis?
to correct losses and anemia. Fluids containing
sodium may be restricted in presence of regional
enteritis.
Answer: The client is free from esophagitis and
achalasia.
R: Dysphagia may be the reason why a client with
esophagitis or achalasia seeks treatment.
Dysphagia is common in patients with erosive
esophagitis but is not a reliable clinical predictor
of severe erosive esophagitis. Dysphagia resolved
with PPI therapy in most cases, but persistent
dysphagia may indicate failed healing. Dysphagia
isn’t associated with rectal tenesmus, duodenal
inflammation, or abnormal gastric structures.
Answer: Notify the physician
R: An NG tube that fails to drain during the
postoperative period should be reported to the
physician immediately. It may be clogged, which
could increase pressure on the suture site
because fluid isn’t draining adequately.
Nasogastric decompression has been routinely
used in most abdominal operations to prevent
the consequences of postoperative ileus.
Answer: Elevated serum lipase
R: Elevation of serum lipase is the most reliable
indicator of pancreatitis because this enzyme is
produced solely by the pancreas. Serum lipase
typically increases 3–6 hours after the onset of
acute pancreatitis and usually peaks at 24 hours.
Unlike amylase, there is significant reabsorption
of lipase in the renal tubules so the serum
concentrations remain elevated for 8–14 days.