Gastrointestinal Questions 1. An adult who has cholecystitis reports clay colored stools and moderate jaundice.

Which is the best explanation for the presence of clay colored stools and jaundice? 1. There is an obstruction in the pancreatic duct. 2. There are gallstones in the gallbladder. 3. Bile is no longer produced by the gallbladder. 4. There is an obstruction in the common bile duct. 2. Atropine 0.5 mg is ordered for a client having an acute attack of cholecystitis. What is the primary purpose of this drug for this client? To 1. decrease skeletal muscle spasms. 2. increase gastrointestinal peristalsis 3. decrease smooth muscle contractions 4. decrease anxiety 3. Following a cholecystectomy, drainage form the T tube for the first 24 hours postoperative was 350 cc. Proper nursing action in response to this should be to 1. notify the physician . 2. raise the level of the drainage bag to decrease rate of flow. 3. increase the IV flow rate to compensate for the loss. 4. continue to observe and measure drainage. 4. An adult male is admitted to the hospital complaining of burning epigastric pain. He reports to the nurse that he has gained 14 pounds over the last two months. Which nursing response is best? 1. “Why were you eating more?” 2. “Has the weight gain been intentional?” 3. “Does your weight usually fluctuate this much?” 4. “How did your eating habits change?” 5. An adult male client is admitted with a diagnosis of probable duodenal ulcer. Which of the following laboratory tests would it be most essential for the nurse to assess immediately? 1. Hemoglobin and Hematocrit 2. SGPT and SGOT 3. Na and K 4. BUN and creatinine 6. An adult client is to have a gastroduodenoscopy in the morning. The nurse’s instructions should include the information that he will be 1. given a general anesthetic during the procedure. 2. given a local anesthetic to ease the discomfort during the procedure. 3. asked to assist by coughing during the procedure. 4. asked to assist by performing a Valsalva maneuver during the procedure. 7. Which nursing intervention is essential immediately following a gastroduodenoscopy? 1. Force fluids. 2. Position him supine. 3. Instruct him not to eat or drink. 4. Encourage coughing and deep breathing. 8. Because a client has a nasogastric tube attached to intermittent drainage the nurse should be particularly alert for the development of which complication? 1. Hypocalcemia. 2. Hypermagnesemia. 3. Hypokalemia. 4. Hypoglycemia. 9. A barium enema is ordered for an adult male client. The nurse is teaching him what to expect regarding the procedure. Which statement should be included in the teaching? 1. Fecal matter must be cleansed from the bowel for good visualization. 2. There will be no food restrictions before the test. 3. He will not have to change positions during the procedure. 4. He will be asked to drink barium during the procedure. 10. An abdomino-perineal resection with a transverse colostomy is planned for an adult male client. Neomycin sulfate p.o. is ordered prior to surgery. The primary purpose for administering this drug is to reduce 1. electrolyte imbalances. 2. bacterial content in the colon. 3. peristaltic action in the colon. 4. feces in the bowel. 11. In preparation for an abdomino-perineal resection the client is placed on a low residue diet. Which of the following food lists is

appropriate for him to eat on a low residue diet? 1. Ground lean beef, soft boiled eggs, tea. 2. Lettuce, spinach, corn. 3. Prunes, grapes, apples. 4. Bran cereal, whole wheat toast, coffee. 12. The nurse is caring for a client who has had a colostomy. Which of the following client behaviors is indicative of a willingness to be involved in self-care following a colostomy? 1. Discussing the cost of his hospitalization. 2. Asking what time the surgeon will be in. 3. Asking questions about the equipment being used. 4. Complaining about the noise in the adjacent room. 13. An adult is admitted with a duodenal ulcer. On the second day after admission, the client develops severe, persistent pain radiating to the shoulder. What action should the nurse take first? 1. Notify the physician. 2. Place client in a high-Fowler’s position to decrease pressure on the gastric area and shoulder. 3. Examine the client for board-like rigidity of the abdomen. 4. Administer ordered prn pain medication. 14. The client with a duodenal ulcer is ready for discharge. Which statement made by the client indicates a need for more teaching about his diet? 1. “It’s a good thing I gave up drinking alcohol last year.” 2. “I will have to drink lots of milk and cream every day.” 3. “I will stay away from cola drinks after I am discharged.” 4. “Eating three nutritious meals and snacks every day is okay.” 15. A young college student comes to the emergency room with nausea, vomiting and severe abdominal pain of six hours duration. While examining the client the physician asks her to stand on her toes and drop to her heels with a thump. Which of the following interpretations of this procedure is the most accurate? 1. An irritated bowel will become less tender. 2. If the client has an acute inflammation she will feel localized pain in the inflamed area. 3. This procedure will create more flaccid abdominal muscles allowing easier abdominal exam. 4. The client with appendicitis will experience brief relief following this action. 16. The nurse is admitting a client with a diagnosis of appendicitis to the surgical unit. Which question is it essential to ask? 1. “When did you last eat?” 2. “Have you had surgery before?” 3. “Have you ever had this type of pain before?” 4. “What do you usually take to relieve your pain? 17. The client with appendicitis asks the nurse for a laxative to help relieve her constipation. The nurse explains to her that laxatives are not given to persons with possible appendicitis. What is the primary reason for this? 1. Laxatives will decrease the spread of infection. 2. Laxatives are not given prior to any type of surgery. 3. The patient does not have true constipation. She only has pressure. 4. Laxatives could cause rupture of the appendix. 18. The nurse is preparing a client with Crohn’s disease for discharge. Which statement he makes indicates he needs further teaching? 1. “Stress can make it worse.” 2. “Since I have Crohn’s disease I don’t have to worry about colon cancer.” 3. “I realize I shall always have to monitor my diet.” 4. “I understand there is a high incidence of familial occurrence with this disease.” 19. A client is admitted to the hospital with ulcerative colitis. Admitting orders include a low residue diet. Which food would be contraindicated for this client? 1. Roast beef. 2. Fresh peas. 3. Mashed potatoes. 4. Baked chicken. 20. An adult client is to have a sigmoidoscopy in the morning. What should the nurse plan to do? 1. Give him an enema 1 hour before the examination. 2. Keep him NPO for 8 hours before the examination. 3. Order a low fat, low residue diet for breakfast. 4. Administer enemas until clear this evening.

21. A client has an order for irrigation of a nasogastric tube. What should the nurse do before irrigating the nasogastric tube? 1. Inject a small amount of air while listening with a stethoscope over the stomach for a “swoosh.” 2. Instill 5 cc of normal saline and observe for development of coughing and dyspnea. 3. Place the end of the nasogastric tube in a glass of water and observe for bubbles. 4. Aspirate and check the pH. 22. The client who has had a hemorrhoidectomy wants to know why she cannot take a sitz bath immediately upon return from the operating room. The nurse’s response is based upon which of the following concepts? 1. Heat can stimulate bowel movement too quickly after surgery. 2. Patients are generally not awake enough for several hours to safely take sitz baths. 3. Heat applied immediately post-operatively increases the possibility of hemorrhage. 4. Sitting in water before the sutures are removed may cause infection. 23. A client with pancreatitis tells the nurse that he fears nighttime. Which of the following statements most likely relates to the client’s concerns? 1. The pain is worse at night and aggravated in the recumbent position. 2. He is afraid of the dark. 3. The mattress is uncomfortable. 4. The pain increases after a day of activity. 24. The client asks how he contracted hepatitis A. He reports all of the following. Which one is most likely related to hepatitis A? 1. He ate home canned tomatoes. 2. He ate oysters his roommate brought home from a fishing trip. 3. He stepped on a nail 2 weeks ago. 4. He donated blood 2 weeks before he got sick. 25. The client has had a liver biopsy. The nurse should position him on his right side with a pillow under his rib cage. What is the primary reason for this position? 1. To immobilize the diaphragm. 2. To facilitate full chest expansion. 3. To minimize the danger of aspiration. 4. To reduce the likelihood of bleeding

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(3) It is essential to keep him NPO until the cough and gag reflexes have returned. He should be in a semiFowler's position to reduce edema formation.

8. (3) Potassium is present in GI fluids and is lost during suctioning. 9. (1) The bowel must be free of fecal material for good visualization of the bowel. He will be on a clear liquid or low residue diet for the day preceding the exam. The client is put in several positions during the test. Barium is given by enema. It is given by mouth in an upper GI series. (2) Neomycin is an antibiotic that is poorly absorbed from the bowel and very effective in killing the bacteria in the bowel. E. Coli, normal inhabitants of the bowel, can cause peritonitis if they are released into the peritoneal cavity during surgery. Neomycin does not alter electrolyte imbalances, affect peristaltic action or reduce feces. (1) All of these foods are low in residue. Fruits, vegetables and whole grains are high in residue. (3) When the client asks questions about the equipment being used, he indicates a readiness to learn. None of the other responses indicate a willingness to learn about his colostomy. (3) The nurse should first do a quick assessment to determine if the cause of the pain is more apt to be perforation of the ulcer or something else such as cardiac pain. If the ulcer has perforated the client's abdomen will be tender and rigid - board like. (2) Milk and cream are now known to cause rebound acidity and are not prescribed for ulcer clients. The other choices all indicate good knowledge. He should not drink alcohol or cola. Three meals and snacks will help to keep the stomach from staying empty for long periods. (2) Rising on the toes will cause pain in McBurney's area if the appendix is inflamed. (1) When a person is admitted with a possible appendicitis the nurse should anticipate surgery. It will be important to know when she last ate when considering the type of anesthesia so that the chance of aspiration can be minimized. (4) Laxatives cause increased peristalsis, which may cause the appendix to rupture. #2 is not a true statement. Laxatives may well be given prior to gynecological, rectal and colon surgery. #3 is true but is not the primary reason why laxatives are not given. (2) Persons with Crohn's disease are at high risk for the development of colon cancer. The other answers are all correct.

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15. Gastrointestinal Quiz Answers and Rationale 1. (4) Clay colored stools means bile is not getting through to the duodenum. The bile duct is obstructed so bile backs up into the bloodstream causing jaundice. (3) Atropine is an anticholinergic drug , which will decrease contractions of the gallbladder. 17. 16.

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3. (4) 350 cc in 24 hours after surgery is a normal amount of bile drainage. 4. (4) Weight gain may occur due to increased consumption of food as the client tries to feed a duodenal ulcer. “Why” questions are threatening to clients. #3 asks for a yes or no answer. This will not give as much information as asking about the eating habits. (1) Hgb and Hct would indicate if there had been any bleeding from the ulcer. SGPT and SGOT elevations indicate liver damage. Na and K indicate electrolyte imbalances. BUN and creatinine elevations would indicate renal disease. (2) Gastroduodenoscopy is visualization of the esophagus, stomach and duodenal through a flexible tube inserted orally. The exam is uncomfortable because the muscles of the GI tract have spasms as the tube is passed. This causes difficulty swallowing. The client is usually given a local anesthetic to the posterior pharynx to reduce the discomfort during the passage of the tube. He may also be given conscious sedation. He will not given a general anesthetic because he must be able to assist by swallowing. Coughing and the performance of a Valsalva maneuver would impede the passage of the tube.

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19. (2) Fresh peas are high in residue. The other foods are low in residue. 20. (1) An enema 1 hour before the exam will clear the sigmoid colon. A client having an upper GI series will be NPO. Low fat diet is indicated prior to a gallbladder series. Low residue diet is part of the preparation for a barium enema. Enemas until clear are sometimes ordered prior to a barium enema. (4) To determine if the tube is in the stomach, the nurse should aspirate and check the pH. It should be less than 5. Never instill saline. If the tube were in the bronchi instead of the stomach, saline would cause respiratory distress. Placing the end of the tube in a glass

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of water does not prove the location of the tube. Injecting air and listening for a “swoosh” does not tell the nurse that the tube is in the stomach. The distal end of the tube could be in the esophagus and still cause a “swoosh.” Instilling fluid in the esophagus would increase the risk of aspiration. 22. (3) Heat causes vasodilation. In the immediate post-operative period this could cause hemorrhaging. Ice packs will be applied for the first 24 hours. Sitz baths are ordered after that. (1) The recumbent position aggravates pancreatic pain. The client will be more comfortable on his side with his knees flexed. (2) Shellfish that grow in contaminated waters may have the virus. Home canned tomatoes might cause food poisoning. Stepping on a nail might cause tetanus. Donating blood will not cause hepatitis. Receiving blood might cause hepatitis B or C.

7. 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? a. Dyspnea and fatigue b. Ascites and orthopnea c. Purpura and petechiae d. Gynecomastia and testicular atrophy 8. Which condition is most likely to have a nursing diagnosis of fluid volume deficit? a. Appendicitis b. Pancreatitis c. Cholecystitis d. Gastric ulcer 9. 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? a. Irrigate the tube with cola. b. Advance the tube into the intestine. c. Apply intermittent suction to the tube. d. Withdraw the obstruction with a 30-ml syringe. 10. A male client with pancreatitis complains of pain. The nurse expects the physician to prescribe meperidine (Demerol) instead of morphine to relieve pain because: a. meperidine provides a better, more prolonged analgesic effect. b. morphine may cause spasms of Oddi’s sphincter. c. meperidine is less addictive than morphine. d. morphine may cause hepatic dysfunction. 11. 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? a. Hopelessness b. Powerlessness c. Chronic low self esteem d. Deficient knowledge 12. Which diagnostic test would be used first to evaluate a client with upper GI bleeding? a. Endoscopy b. Upper GI series c. Hemoglobin (Hb) levels and hematocrit (HCT) d. Arteriography 13. 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? a. “You may have eaten contaminated restaurant food.” b. “You could have gotten it by using I.V. drugs.” c. “You must have received an infected blood transfusion.” d. “You probably got it by engaging in unprotected sex.” 14. 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. Obstruction of the appendix may increase venous drainage and cause the appendix to rupture. b. Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix. c. The appendix may develop gangrene and rupture, especially in a middle-aged client. d. Infection of the appendix diminishes necrotic arterial blood flow and increases venous drainage. 15. 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: a. whole blood and albumin. b. platelets and packed red blood cells. c. fresh frozen plasma and whole blood. d. cryoprecipitate and fresh frozen plasma. 16. To prevent gastroesophageal reflux in a male client with hiatal hernia, the nurse should provide which discharge instruction? a. “Lie down after meals to promote digestion.” b. “Avoid coffee and alcoholic beverages.” c. “Take antacids with meals.” d. “Limit fluid intake with meals.”

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(4) The liver is a very vascular organ. It is located on the right side. Lying on the right side will put pressure on it and provide hemostasis. http://nurse.nonoy.net/2010/06/nclex-review-gastrointestinalquestions/ 1. During preparation for bowel surgery, a male client receives an antibiotic to reduce intestinal bacteria. Antibiotic therapy may interfere with synthesis of which vitamin and may lead to hypoprothrombinemia? a. vitamin A b. vitamin D c. vitamin E d. vitamin K 2. When evaluating a male client for complications of acute pancreatitis, the nurse would observe for: a. increased intracranial pressure. b. decreased urine output. c. bradycardia. d. hypertension. 3. 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. Lying on the right side with legs straight b. Lying on the left side with knees bent c. Prone with the torso elevated d. Bent over with hands touching the floor 4. 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 a client history from the client’s wife. The question by the nurse that demonstrates her understanding of Mallory-Weiss tearing is: a. “Tell me about your husband’s alcohol usage.” b. “Is your husband being treated for tuberculosis?” c. “Has your husband recently fallen or injured his chest?” d. “Describe spices and condiments your husband uses on food.” 5. Which of the following nursing interventions should the nurse perform for a female client receiving enteral feedings through a gastrostomy tube? a. Change the tube feeding solutions and tubing at least every 24 hours. b. Maintain the head of the bed at a 15-degree elevation continuously. c. Check the gastrostomy tube for position every 2 days. d. Maintain the client on bed rest during the feedings. 6. 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’s onset of action occur? a. 5 to 10 minutes b. 15 to 30 minutes c. 30 to 60 minutes d. 2 to 4 hours

17. The nurse caring for a client with small-bowel obstruction would plan to implement which nursing intervention first? a. Administering pain medication b. Obtaining a blood sample for laboratory studies c. Preparing to insert a nasogastric (NG) tube d. Administering I.V. fluids 18. A female client with dysphagia is being prepared for discharge. Which outcome indicates that the client is ready for discharge? a. The client doesn’t exhibit rectal tenesmus. b. The client is free from esophagitis and achalasia. c. The client reports diminished duodenal inflammation. d. The client has normal gastric structures. 19. 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? a. Notify the physician b. Reposition the tube c. Irrigate the tube d. Increase the suction level 20. What laboratory finding is the primary diagnostic indicator for pancreatitis? a. Elevated blood urea nitrogen (BUN) b. Elevated serum lipase c. Elevated aspartate aminotransferase (AST) d. Increased lactate dehydrogenase (LD) 21. A male client with cholelithiasis has a gallstone lodged in the common bile duct. When assessing this client, the nurse expects to note: a. yellow sclerae. b. light amber urine. c. circumoral pallor. d. black, tarry stools. 22. Nurse Hannah is teaching a group of middle-aged men about peptic ulcers. When discussing risk factors for peptic ulcers, the nurse should mention: a. a sedentary lifestyle and smoking. b. a history of hemorrhoids and smoking. c. alcohol abuse and a history of acute renal failure. d. alcohol abuse and smoking. 23. While palpating a female client’s right upper quadrant (RUQ), the nurse would expect to find which of the following structures? a. Sigmoid colon b. Appendix c. Spleen d. Liver 24. A male client has undergone a colon resection. While turning him, wound dehiscence with evisceration occurs. The nurse’s first response is to: a. call the physician. b. place saline-soaked sterile dressings on the wound. c. take a blood pressure and pulse. d. pull the dehiscence closed. 25. The nurse is monitoring a female client receiving paregoric to treat diarrhea for drug interactions. Which drugs can produce additive constipation when given with an opium preparation? a. Antiarrhythmic drugs b. Anticholinergic drugs c. Anticoagulant drugs d. Antihypertensive drugs 26. A male client is recovering from an ileostomy that was performed to treat inflammatory bowel disease. During discharge teaching, the nurse should stress the importance of: a. increasing fluid intake to prevent dehydration. b. wearing an appliance pouch only at bedtime. c. consuming a low-protein, high-fiber diet. d. taking only enteric-coated medications. 27. The nurse is caring for a female client with active upper GI bleeding. What is the appropriate diet for this client during the first 24 hours after admission? a. Regular diet b. Skim milk c. Nothing by mouth d. Clear liquids 28. A male client has just been diagnosed with hepatitis A. On assessment, the nurse expects to note:

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severe abdominal pain radiating to the shoulder. anorexia, nausea, and vomiting. eructation and constipation. abdominal ascites.

29. A female client with viral hepatitis A is being treated in an acute care facility. Because the client requires enteric precautions, the nurse should: a. place the client in a private room. b. wear a mask when handling the client’s bedpan. c. wash the hands after touching the client. d. wear a gown when providing personal care for the client. 30. a. b. c. d. Which of the following factors can cause hepatitis A? Contact with infected blood Blood transfusions with infected blood Eating contaminated shellfish Sexual contact with an infected person

1. Answer D. Intestinal bacteria synthesize such nutritional substances as vitamin K, thiamine, riboflavin, vitamin B12, folic acid, biotin, and nicotinic acid. Therefore, antibiotic therapy may interfere with synthesis of these substances, including vitamin K. Intestinal bacteria don’t synthesize vitamins A, D, or E. 2. Answer B. Acute pancreatitis can cause decreased urine output, which results from the renal failure that sometimes accompanies this condition. Intracranial pressure neither increases nor decreases in a client with pancreatitis. Tachycardia, not bradycardia, usually is associated with pulmonary or hypovolemic complications of pancreatitis. Hypotension can be caused by a hypovolemic complication, but hypertension usually isn’t related to acute pancreatitis. 3. Answer B. For a colonoscopy, the nurse initially should position the client on the left side with knees bent. Placing the client on the right side with legs straight, prone with the torso elevated, or bent over with hands touching the floor wouldn’t allow proper visualization of the large intestine. 4. Answer A. 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. The bleeding is coming from the stomach, not from the lungs as would be true in some cases of tuberculosis. A Mallory-Weiss tear doesn’t occur from chest injuries or falls and isn’t associated with eating spicy foods. 5. Answer A. Tube feeding solutions and tubing should be changed every 24 hours, or more frequently if the feeding requires it. Doing so prevents contamination and bacterial growth. The head of the bed should be elevated 30 to 45 degrees continuously to prevent aspiration. Checking for gastrostomy tube placement is performed before initiating the feedings and every 4 hours during continuous feedings. Clients may ambulate during feedings. 6. Answer B. 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. 7. Answer C. 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. Dyspnea and fatigue suggest anemia. Ascites and orthopnea are unrelated to vitamin K absorption. Gynecomastia and testicular atrophy result from decreased estrogen metabolism by the diseased liver. 8. Answer B. Hypovolemic shock from fluid shifts is a major factor in acute pancreatitis. The other conditions are less likely to exhibit fluid volume deficit. 9. Answer A. The nurse should irrigate the tube with cola because its effervescence and acidity are suited to the purpose, it’s inexpensive, and it’s readily available in most homes. Advancing the NG tube is inappropriate because the tube is designed to stay in the stomach and isn’t long enough to reach the intestines. Applying intermittent suction or using a syringe for aspiration is unlikely to dislodge the material clogging the tube but may create excess pressure. Intermittent suction may even collapse the tube. 10. Answer B. 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. Meperidine has

a somewhat shorter duration of action than morphine. The two drugs are equally addictive. Morphine isn’t associated with hepatic dysfunction. 11. Answer C. Young women with Chronic low self esteem — are at highest risk for anorexia nervosa because they perceive being thin as a way to improve their self-confidence. Hopelessness and Powerlessness are inappropriate nursing diagnoses because clients with anorexia nervosa seldom feel hopeless or powerless; instead, they use food to control their desire to be thin and hope that restricting food intake will achieve this goal. Anorexia nervosa doesn’t result from a knowledge deficit, such as one regarding good nutrition. 12. Answer A. Endoscopy permits direct evaluation of the upper GI tract and can detect 90% of bleeding lesions. 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. Hb levels and HCT, which indicate loss of blood volume, aren’t always reliable indicators of GI bleeding because a decrease in these values may not be seen for several hours. Arteriography is an invasive study associated with life-threatening complications and wouldn’t be used for an initial evaluation. 13. Answer A. Hepatitis A virus typically is transmitted by the oral-fecal route — commonly by consuming food contaminated by infected food handlers. The virus isn’t transmitted by the I.V. route, blood transfusions, or unprotected sex. Hepatitis B can be transmitted by I.V. drug use or blood transfusion. Hepatitis C can be transmitted by unprotected sex. 14. Answer B. 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. Inflammation and bacterial growth follow, and swelling continues to raise pressure within the appendix, resulting in gangrene and rupture. Geriatric, not middle-aged, clients are especially susceptible to appendix rupture. 15. Answer D. 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. Although administering whole blood, albumin, and packed cells will contribute to hemostasis, those products aren’t specifically used to treat hemostasis. Platelets are helpful, but the best answer is cryoprecipitate and fresh frozen plasma. 16. Answer B. To prevent reflux of stomach acid into the esophagus, the nurse should advise the client to avoid foods and beverages that increase stomach acid, such as coffee and alcohol. The nurse also should teach the client to avoid lying down after meals, which can aggravate reflux, and to take antacids after eating. The client need not limit fluid intake with meals as long as the fluids aren’t gastric irritants. 17. Answer D. I.V. infusions containing normal saline solution and potassium should be given first to maintain fluid and electrolyte balance. For the client’s comfort and to assist in bowel decompression, the nurse should prepare to insert an NG tube next. A blood sample is then obtained for laboratory studies to aid in the diagnosis of bowel obstruction and guide treatment. Blood studies usually include a complete blood count, serum electrolyte levels, and blood urea nitrogen level. Pain medication often is withheld until obstruction is diagnosed because analgesics can decrease intestinal motility. 18. Answer B. Dysphagia may be the reason why a client with esophagitis or achalasia seeks treatment. Dysphagia isn’t associated with rectal tenesmus, duodenal inflammation, or abnormal gastric structures. 19. Answer A. 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. Repositioning or irrigating an NG tube in a client who has undergone gastric surgery can disrupt the anastomosis. Increasing the level of suction may cause trauma to GI mucosa or the suture

line. 20. Answer B. Elevation of serum lipase is the most reliable indicator of pancreatitis because this enzyme is produced solely by the pancreas. A client’s BUN is typically elevated in relation to renal dysfunction; the AST, in relation to liver dysfunction; and LD, in relation to damaged cardiac muscle. 21. Answer A. Yellow sclerae may be the first sign of jaundice, which occurs when the common bile duct is obstructed. Urine normally is light amber. Circumoral pallor and black, tarry stools don’t occur in common bile duct obstruction; they are signs of hypoxia and GI bleeding, respectively. 22. Answer D. Risk factors for peptic (gastric and duodenal) ulcers include alcohol abuse, smoking, and stress. A sedentary lifestyle and a history of hemorrhoids aren’t risk factors for peptic ulcers. Chronic renal failure, not acute renal failure, is associated with duodenal ulcers. 23. Answer D. The RUQ contains the liver, gallbladder, duodenum, head of the pancreas, hepatic flexure of the colon, portions of the ascending and transverse colon, and a portion of the right kidney. The sigmoid colon is located in the left lower quadrant; the appendix, in the right lower quadrant; and the spleen, in the left upper quadrant. 24. Answer B. The nurse should first place saline-soaked sterile dressings on the open wound to prevent tissue drying and possible infection. Then the nurse should call the physician and take the client’s vital signs. The dehiscence needs to be surgically closed, so the nurse should never try to close it. 25. Answer B. Paregoric has an additive effect of constipation when used with anticholinergic drugs. Antiarrhythmics, anticoagulants, and antihypertensives aren’t known to interact with paregoric. 26. Answer A. Because stool forms in the large intestine, an ileostomy typically drains liquid waste. To avoid fluid loss through ileostomy drainage, the nurse should instruct the client to increase fluid intake. The nurse should teach the client to wear a collection appliance at all times because ileostomy drainage is incontinent, to avoid high-fiber foods because they may irritate the intestines, and to avoid enteric-coated medications because the body can’t absorb them after an ileostomy 27. Answer C. Shock and bleeding must be controlled before oral intake, so the client should receive nothing by mouth. A regular diet is incorrect. When the bleeding is controlled, the diet is gradually increased, starting with ice chips and then clear liquids. Skim milk shouldn’t be given because it increases gastric acid production, which could prolong bleeding. A liquid diet is the first diet offered after bleeding and shock are controlled. 28. Answer B. Hallmark signs and symptoms of hepatitis A include anorexia, nausea, vomiting, fatigue, and weakness. Abdominal pain may occur but doesn’t radiate to the shoulder. Eructation and constipation are common in gallbladder disease, not hepatitis A. Abdominal ascites is a sign of advanced hepatic disease, not an early sign of hepatitis A. 29. Answer C. To maintain enteric precautions, the nurse must wash the hands after touching the client or potentially contaminated articles and before caring for another client. A private room is warranted only if the client has poor hygiene — for instance, if the client is unlikely to wash the hands after touching infective material or is likely to share contaminated articles with other clients. For enteric precautions, the nurse need not wear a mask and must wear a gown only if soiling from fecal matter is likely. 30. Answer C. Hepatitis A can be caused by consuming contaminated water, milk, or food — especially shellfish from contaminated water. Hepatitis B is caused by blood and sexual contact with an infected person. Hepatitis C is usually caused by contact with infected blood, including receiving blood transfusions.

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