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1. Nurse Berlinda is assigned to a 41-year-old client who has a diagnosis of chronic pancreatitis. The nurse reviews the laboratory result, anticipating a laboratory report that indicates a serum amylase level of: a. b. c. d. 45 units/L 100 units/L 300 units/L 500 units/L
2. A male client who is recovering from surgery has been advanced from a clear liquid diet to a full liquid diet. The client is looking forward to the diet change because he has been “bored” with the clear liquid diet. The nurse would offer which full liquid item to the client? a. b. c. d. Tea Gelatin Custard Popsicle
3. Nurse Juvy is caring for a client with cirrhosis of the liver. To minimize the effects of the disorder, the nurse teaches the client about foods that are high in thiamine. The nurse determines that the client has the best understanding of the dietary measures to follow if the client states an intension to increase the intake of: a. Pork b. Milk c. Chicken d. Broccoli 4. Nurse Oliver checks for residual before administering a bolus tube feeding to a client with a nasogastric tube and obtains a residual amount of 150 mL. What is appropriate action for the nurse to take? a. Hold the feeding b. Reinstill the amount and continue with administering the feeding c. Elevate the client’s head at least 45 degrees and administer the feeding d. Discard the residual amount and proceed with administering the feeding 5. A nurse is inserting a nasogastric tube in an adult male client. During the procedure, the client begins to cough and has difficulty breathing. Which of the following is the appropriate nursing action? a. Quickly insert the tube b. Notify the physician immediately c. Remove the tube and reinsert when the respiratory distress subsides d. Pull back on the tube and wait until the respiratory distress subsides 6. Nurse Ryan is assessing for correct placement of a nosogartric tube. The nurse aspirates the stomach contents and check the contents for pH. The nurse verifies correct tube placement if which pH value is noted? a. 3.5 b. 7.0 c. 7.35 d. 7.5
7. A nurse is preparing to remove a nasogartric tube from a female client. The nurse should instruct the client to do which of the following just before the nurse removes the tube? a. b. c. d. Exhale Inhale and exhale quickly Take and hold a deep breath Perform a Valsalva maneuver
8. Nurse Joy is preparing to administer medication through a nasogastric tube that is connected to suction. To administer the medication, the nurse would: a. Position the client supine to assist in medication absorption b. Aspirate the nasogastric tube after medication administration to maintain patency c. Clamp the nasogastric tube for 30 minutes following administration of the medication d. Change the suction setting to low intermittent suction for 30 minutes after medication administration 9. A nurse is preparing to care for a female client with esophageal varices who has just has a Sengstaken-Blakemore tube inserted. The nurse gathers supplies, knowing that which of the following items must be kept at the bedside at all times? a. b. c. d. An obturator Kelly clamp An irrigation set A pair of scissors
10. Dr. Smith has determined that the client with hepatitis has contracted the infection form contaminated food. The nurse understands that this client is most likely experiencing what type of hepatitis? a. Hepatitis A b. Hepatitis B c. Hepatitis C d. Hepatitis D 11. A client is suspected of having hepatitis. Which diagnostic test result will assist in confirming this diagnosis? a. Elevated hemoglobin level b. Elevated serum bilirubin level c. Elevated blood urea nitrogen level d. Decreased erythrocycle sedimentation rate 12. The nurse is reviewing the physician’s orders written for a male client admitted to the hospital with acute pancreatitis. Which physician order should the nurse question if noted on the client’s chart? a. b. c. d. NPO status Nasogastric tube inserted Morphine sulfate for pain An anticholinergic medication
13. A female client being seen in a physician’s office has just been scheduled for a barium swallow the next day. The nurse writes down which instruction for the client to follow before the test? a. Fast for 8 hours before the test b. Eat a regular supper and breakfast
c. Continue to take all oral medications as scheduled d. Monitor own bowel movement pattern for constipation 14. The nurse is performing an abdominal assessment and inspects the skin of the abdomen. The nurse performs which assessment technique next? a. b. c. d. Palpates the abdomen for size Palpates the liver at the right rib margin Listens to bowel sounds in all for quadrants Percusses the right lower abdominal quadrant
15. Polyethylene glycol-electrlyte solution (GoLYTELY) is prescribed for the female client scheduled for a colonoscopy. The client begins to experience diarrhea following administration of the solution. What action by the nurse is appropriate? a. Start an IV infusion b. Administer an enema c. Cancel the diagnostic test d. Explain that diarrhea is expected 16. The nurse is caring for a male client with a diagnosis of chronic gastritis. The nurse monitors the client knowing that this client is at risk for which vitamin deficiency? a. Vitamin A b. Vitamin B12 c. Vitamin C d. Vitamin E 17. The nurse is reviewing the medication record of a female client with acute gastritis. Which medication, if noted on the client’s record, would the nurse question? a. b. c. d. Digoxin (Lanoxin) Furosemide (Lasix) Indomethacin (Indocin) Propranolol hydrochloride (Inderal)
18. The nurse is assessing a male client 24 hours following a cholecystectomy. The nurse noted that the T tube has drained 750 mL of green-brown drainage since the surgery. Which nursing intervention is appropriate? a. Clamp the T tube b. Irrigate the T tube c. Notify the physician d. Document the findings 19. The nurse is monitoring a female client with a diagnosis of peptic ulcer. Which assessment findings would most likely indicate perforation of the ulcer? a. Bradycardia b. Numbness in the legs c. Nausea and vomiting d. A rigid, board-like abdomen 20. A male client with a peptic ulcer is scheduled for a vagotomy and the client asks the nurse about the purpose of this procedure. Which response by the nurse best describes the purpose of a vagotomy?
The nurse is instructing the male client who has an inguinal hernia repair how to reduce postoperative swelling following the procedure. Irrigating the drain b. b. Which postoperative order should the nurse question and verify? a. Maintaining bed rest d. Abdominal cramping and pain 24. Leg exercises Early ambulation Irrigating the nasogastric tube Coughing and deep-breathing exercises 22. What should the nurse tell the client? a. Hypotension Bloody diarrhea Rebound tenderness A hemoglobin level of 12 mg/dL 27. The nurse is caring for a female client following a Billroth II procedure. d. Halts stress reactions Heals the gastric mucosa Reduces the stimulus to acid secretions Decreases food absorption in the stomach 21. d. The nurse is preparing a discharge teaching plan for the male client who had umbilical hernia repair. The nurse is monitoring a female client for the early signs and symptoms of dumping syndrome. Avoiding coughing c. b. c. What should the nurse include in the plan? a. Which of the following indicate this occurrence? a. would the nurse report to the physician? a. b. b. Sweating and pallor b. Bradycardia and indigestion c. if noted on assessment of the client. d. The nurse is caring for a hospitalized female client with a diagnosis of ulcerative colitis. The nurse is providing discharge instructions to a male client following gastrectomy and instructs the client to take which measure to assist in preventing dumping syndrome? a. Body image. Ambulate following a meal Eat high carbohydrate foods Limit the fluid taken with meal Sit in a high-Fowler’s position during meals 23. Remain in a low-fiber diet 26. Limit oral fluid b. c. d. disturbed . The nurse is caring for a male client postoperatively following creation of a colostomy. c. Sexual dysfunction b. Which finding. c. Elevate the scrotum c. Double vision and chest pain d. Restricting pain medication 25. Apply heat to the abdomen d.a. Which nursing diagnosis should the nurse include in the plan of care? a.
A male client with a recent history of rectal bleeding is being prepared for a colonoscopy. Which stool characteristics should the nurse expect to note documented in the client’s record? a. Reduce the amount of irrigation solution Part 2 1. Place heat on the abdomen c. Stop the irrigation temporarily c. vitamin D c. vitamin A b. a male client receives an antibiotic to reduce intestinal bacteria. The nurse is teaching a female client how to perform a colostomy irrigation. Lying on the right side with legs straight b. During preparation for bowel surgery. c. decreased urine output. Lying on the left side with knees bent . hypertension. Stools constantly oozing form the rectum 29. bradycardia. Increase the height of the irrigation d. the client begins to complain of abdominal cramps. vitamin E d. During the irrigation. Increase fluid intake b. How should the nurse position the client for this test initially? a. Constipation alternating with diarrhea d. increased intracranial pressure. Notify the physician b. Chronic constipation c. what measure should the nurse instruct the client to do? a. Perform the irrigation in the evening d.c. What is the appropriate nursing action? a. Medicate for pain and resume the irrigation 30. the nurse would observe for: a. The nurse is performing a colostomy irrigation on a male client. b. Nutrition: more than body requirements. imbalanced 28. vitamin K 2. The nurse is reviewing the record of a female client with Crohn’s disease. When evaluating a male client for complications of acute pancreatitis. 3. Diarrhea b. To enhance the effectiveness of the irrigation and fecal returns. d. Antibiotic therapy may interfere with synthesis of which vitamin and may lead to hypoprothrombinemia? a. Fear related to poor prognosis d.
Prone with the torso elevated d. b. Maintain the head of the bed at a 15-degree elevation continuously. Check the gastrostomy tube for position every 2 days. Which assessment findings indicate that the client has deficient vitamin K absorption caused by this hepatic disease? a. To remedy this problem and teach the client’s family how to deal with it at home. Appendicitis b. c. 75 mg I. “Describe spices and condiments your husband uses on food. Pancreatitis c. d. the nasogastric (NG) feeding tube becomes clogged. “Is your husband being treated for tuberculosis?” c. The question by the nurse that demonstrates her understanding of MalloryWeiss tearing is: a. the physician prescribes meperidine (Demerol).M. Maintain the client on bed rest during the feedings. and the nurse begins taking a client history from the client’s wife. The nurse is caring for a male client with cirrhosis. “Has your husband recently fallen or injured his chest?” d. c. 30 to 60 minutes d. “Tell me about your husband’s alcohol usage. Which condition is most likely to have a nursing diagnosis of fluid volume deficit? a.” 5. and disorientation is admitted to the emergency department. 15 to 30 minutes c. How soon after administration should meperidine’s onset of action occur? a. The nurse expects the physician to prescribe meperidine (Demerol) instead of morphine to relieve pain because: . pallor. Apply intermittent suction to the tube. weak peripheral pulses.” b. b. Withdraw the obstruction with a 30-ml syringe. Cholecystitis d. Bent over with hands touching the floor 4. To relieve pain. 10. Irrigate the tube with cola. A male client is recovering from a small-bowel resection. His wife reports that he has been “spitting up blood. c. A male client with pancreatitis complains of pain. While a female client is being prepared for discharge. Which of the following nursing interventions should the nurse perform for a female client receiving enteral feedings through a gastrostomy tube? a.” A Mallory-Weiss tear is suspected. A male client with extreme weakness. every 4 hours.c. d. Dyspnea and fatigue Ascites and orthopnea Purpura and petechiae Gynecomastia and testicular atrophy 8. what should the nurse do? a. Gastric ulcer 9. d. 2 to 4 hours 7. 6. Advance the tube into the intestine. 5 to 10 minutes b. b. Change the tube feeding solutions and tubing at least every 24 hours.
meperidine is less addictive than morphine. Infection of the appendix diminishes necrotic arterial blood flow and increases venous drainage. platelets and packed red blood cells. Hopelessness Powerlessness Chronic low self esteem Deficient knowledge 12. an adolescent girl is admitted to an acute care facility with severe malnutrition. fresh frozen plasma and whole blood. After a thorough examination. “Take antacids with meals. d. When preparing a male client.V. d. for surgery to treat appendicitis. age 51. “You may have eaten contaminated restaurant food. morphine may cause hepatic dysfunction. c. “You probably got it by engaging in unprotected sex. the nurse should provide which discharge instruction? a. A female client who has just been diagnosed with hepatitis A asks. “Limit fluid intake with meals. 11.” d. The appendix may develop gangrene and rupture. the nurse formulates a nursing diagnosis of Risk for infection related to inflammation. d. 16. leading to ischemia. d. To prevent gastroesophageal reflux in a male client with hiatal hernia. the physician diagnoses anorexia nervosa. more prolonged analgesic effect.” c. drugs.” 14. “Avoid coffee and alcoholic beverages. 15. morphine may cause spasms of Oddi’s sphincter. When developing the plan of care for this client.” d.” b. “You must have received an infected blood transfusion. The blood products that would most likely bring about hemostasis in the client are: a. and rupture of the appendix. What is the rationale for choosing this nursing diagnosis? a. perforation. Obstruction of the appendix reduces arterial flow. b. the nurse is most likely to include which nursing diagnosis? a. b. d. inflammation. cryoprecipitate and fresh frozen plasma. c.” c. c.” . meperidine provides a better. whole blood and albumin. b. Mandy.” b. “How could I have gotten this disease?” What is the nurse’s best response? a.a. and surgery. b. c. Endoscopy Upper GI series Hemoglobin (Hb) levels and hematocrit (HCT) Arteriography 13. c. Obstruction of the appendix may increase venous drainage and cause the appendix to rupture. especially in a middle-aged client. “You could have gotten it by using I. “Lie down after meals to promote digestion. Which diagnostic test would be used first to evaluate a client with upper GI bleeding? a. b. A female client with hepatitis C develops liver failure and GI hemorrhage.
alcohol abuse and smoking. The client reports diminished duodenal inflammation. Administering pain medication b. Several hours after surgery. d. alcohol abuse and a history of acute renal failure. Preparing to insert a nasogastric (NG) tube d. a sedentary lifestyle and smoking. Elevated aspartate aminotransferase (AST) d. c. the nurse should mention: a.17. 19. Increase the suction level 20. b. c. Sigmoid colon b. Spleen d. c. a history of hemorrhoids and smoking. While palpating a female client’s right upper quadrant (RUQ). b. Obtaining a blood sample for laboratory studies c. Which outcome indicates that the client is ready for discharge? a. Notify the physician b. Elevated serum lipase c. The client has normal gastric structures. A male client with cholelithiasis has a gallstone lodged in the common bile duct. d. Liver . d. 22. tarry stools. Elevated blood urea nitrogen (BUN) b. the nurse notes that the client’s nasogastric (NG) tube has stopped draining. Reposition the tube c. b.V. Nurse Hannah is teaching a group of middle-aged men about peptic ulcers. black. A female client with dysphagia is being prepared for discharge. Increased lactate dehydrogenase (LD) 21. A male client undergoes total gastrectomy. The client is free from esophagitis and achalasia. the nurse expects to note: a. Appendix c. circumoral pallor. 23. How should the nurse respond? a. When assessing this client. Irrigate the tube d. yellow sclerae. What laboratory finding is the primary diagnostic indicator for pancreatitis? a. Administering I. fluids 18. The client doesn’t exhibit rectal tenesmus. light amber urine. the nurse would expect to find which of the following structures? a. The nurse caring for a client with small-bowel obstruction would plan to implement which nursing intervention first? a. When discussing risk factors for peptic ulcers.
b. c. Contact with infected blood Blood transfusions with infected blood Eating contaminated shellfish Sexual contact with an infected person Part 3 . nausea. high-fiber diet. b. anorexia. b. call the physician. d. A male client has just been diagnosed with hepatitis A. and vomiting. What is the appropriate diet for this client during the first 24 hours after admission? a. place the client in a private room. b. c. wearing an appliance pouch only at bedtime. A male client is recovering from an ileostomy that was performed to treat inflammatory bowel disease. Which of the following factors can cause hepatitis A? a. taking only enteric-coated medications. wear a mask when handling the client’s bedpan. c. the nurse should stress the importance of: a. 30. the nurse should: a. abdominal ascites. d. take a blood pressure and pulse. Because the client requires enteric precautions. d. b. wound dehiscence with evisceration occurs. Which drugs can produce additive constipation when given with an opium preparation? a. While turning him. Antiarrhythmic drugs b. the nurse expects to note: a. place saline-soaked sterile dressings on the wound. wear a gown when providing personal care for the client. The nurse is caring for a female client with active upper GI bleeding. severe abdominal pain radiating to the shoulder. A female client with viral hepatitis A is being treated in an acute care facility. During discharge teaching. b.24. The nurse is monitoring a female client receiving paregoric to treat diarrhea for drug interactions. d. consuming a low-protein. On assessment. c. d. Antihypertensive drugs 26. increasing fluid intake to prevent dehydration. Anticoagulant drugs d. A male client has undergone a colon resection. Regular diet Skim milk Nothing by mouth Clear liquids 28. 25. wash the hands after touching the client. eructation and constipation. pull the dehiscence closed. c. The nurse’s first response is to: a. 27. 29. c. Anticholinergic drugs c. d.
Greg is most likely to: a) lie on his left side b) turn into his stomach c) rigidly maintain the supine position d) draw his knees up to his abdomen 7. A nurse is caring for a client with colostomy created 3 days earlier. She is for colostomy. To relieve the pain caused by perforation. six times daily d) avoid concentrated sweets Situation: Mr.1. "The doctor told me that there are complications of colostomy. will not make eye contact and does not speak to family or visitors. The client has been diagnosed to have cancer of the colon. a 49 year old CEO is diagnosed as having ulcer disease. Mr. The client had been diagnosed to have a cholelithiasis. A client who has gastrostomy tube for feeding refuses to participate in the plan of care. expected event b) this indicates inadequate preoperative bowel preparation c) the client is experiencing early signs of impaired circulation d) the client should not have the nasogastric tube movement 4. Which medication reduces hydrochloride acid secretion? a) cimetidine (tagamet) b) sucralfate (carafets) c) aluminum hydroxide (amphogel) . The client says. Which of the following would not be a component of this teaching plan? a) lie down after eating b) drink liquids with meals c) eat small meals. He had undergone laparoscopic cholecystectomy. Mr. The nurse interprets that: a) this is normal. 6." The best initial action by the nurse is a) discuss complications of colostomy to the patient b) provide pre-operation teachings c) ask what are the complications of colostomy d) ask the client to sign consent form 3. Greg's ulcer perforates into the peritoneal cavity. Which of the following does the nurse recognize as normal signs andsymptoms after the surgery? a) abdominal pain and bloating b) diminished lung sounds c) bile-stained vomitus d) hyperactive bowel sounds 2. Greg. Greg is placed on the bland diet and receives medications to decrease gastric acidity. Mr. A nurse is preparing a diet plan for a post-gastrectomy client to prevent dumping syndrome. The client is beginning to pass malodorous flatus from stoma. A nurse assesses that this client is using which type of coping mechanism? a) self-control b) distancing c) problem-solving d) accepting responsibility 5.
Which of the following statements when made by the mother of a child with celiac disease indicates that she understands the diet of her child? a) my child can eat rice b) my child can eat oats . Which of the following is not to be included in the nursing care plan for the client to prevent dumping syndrome? a) small. Greg is scheduled for an upper GI series.d) aspirin 8. Which of the following should the nurse advise to a client who had undergone partial gastrectomy? a) drink fluid with meals b) lie down after meals c) increase fats in the diet d) assume upright position during and after meals 15. When is the best time to administer sucralfate? a) one hour before meals b) 30 minutes after meals c) with meals d) 2 hours after meals 13. What diet should the nurse recommend for a child with celiac disease? a) wheat and oats b) rice and corn c) cookies and ice cream d) pasta and noodles 10. low carbohydrate diet c) lying down after meals d) taking fluids with meals 12. Which of the following should the nurse include when giving health teachings in a client with gastroesophageal reflux? a) lie down after meals b) sleep with the head of bed elevated c) eat high carbohydrate diet d) eat low protein diet 14. Mr. Which intervention should the nurse perform after procedure? a) testing stool for occult blood b) give the patient a laxative c) assessing for the gag reflex d) administer double dose of antacids to prevent excessive HCL production 9. A client had undergone gastric resection. Which of the following foods should not be included in the diet of the client with diverticulitis? a) rice and steamed chicken b) tomato and cucumber c) pasta and orange slices d) roasted turkey and spaghetti 11. frequent feeding b) high protein.
c) my child can eat biscuits d) my child can eat pasta 16. Which of the following statements when made by the client indicates that he understands the health teachings a) I'll take vitamin K for life b) I'll take vitamin B12 for life c) I'll take vitamin C for life d) I'll take vitamin B6 for life 20. A client diagnosed with gastric ulcer is for discharge. with IV fluid and foley catheter. Which of the following should the nurse include when giving health teachings? Select all that apply a) avoid spicy foods b) avid straining at stool c) increase fluid intake d) open mouth if coughing or sneezing could not be avoided e) avoid bending or stooping f) take acetaminophen instead of aspirin for pain g) avoid heavy lifting 21. The client who was diagnosed to have gastric cancer had undergone gastrectomy. Which of the following tasks may be delegated to the nursing assistant? a) assist the client in taking a bath b) hourly intake and output monitoring c) assist the client to sit before changing the bed linen d) assist the client in ambulation 18. The client had been diagnosed to have liver cirrhosis and esophageal varices. The client had undergone ileostomy. Which of the following should be included by the nurse in the health teachings regarding diet? a) you must eat bland diet b) you can eat most foods as long as they don't bother your stomach c) you should refrain from eating fruits and vegetables d) you should eat low fiber diet 19. when assessing client who had undergone colonoscopy? a) abdominal distention b) 300 ml of bile-stained vomitus c) complaints of anal pain d) complaints of drowsiness and fatigue 17. Which of the following assessment findings should concern the nurse most. He has nasogastric tube connected to intermittent suction. Which of the following findings indicates effectiveness of Viokase? a) abdominal pain relieved b) steatorrhea has decreased c) vomiting has stopped d) jaundice has diminished 22. Which of the following physician's instructions requires intervention by thew nurse? . A client has hepatic cirrhosis and gastric bleeding.
To prevent dumping syndrome. Which of the following manifestations characterize pancreatitis? a) right upper quadrant pain b) bile-stained vomitus c) epigastric pain that is not relieved by vomiting d) elevated serum calcium 24. SGPT b) elevated BUN. ESR d) elevated serum amylase. The client is diagnosed with acute pancreatitis. The client is diagnosed to have acute pancreatitis. which of the following is not a component of the interventions? a) eating small frequent meals b) lying down after meals for 30 minutes c) drinking fluids during meals d) avoiding concentrated sugar 27. The client had gastrectomy 2 days ago. A fluid challenge is begun with a postop gastric surgery client. Which of the following signs and symptoms will the client manifest? a) right upper quadrant (RUQ) pain b) bluish discoloration at the periumbilical area c) left lower quadrant (LLQ) pain d) pain at the epigastric region 25.a) remove the NGT on the third day postop b) remove foley catheter after 24 hours c) irrigate ileostomy at bed time d) clear liquid diet once peristalsis returns 23. BUN levels 29. Which assessment will give the best indication of the client's response to this treatment? a) CVP (central venous pressure) reading and hourly urine output b) blood pressure and apical rate c) lung sounds and arterial blood gases d) electrolytes. Which of the following facts best explains why the duodenum is not removed during a subtotal gastrectomy? a) the head of the pancreas is adherent to the duodenal wall b) the common bile duct empties into the duodenal villi c) the wall of the jejunum contains no intestinal villi . After liver biopsy. lipase 26. Which laboratory findings signify the diagnosis? a) elevated SGOT. serum creatinine c) elevated FBS. what is the most appropriate next action of the RN? a) take vital signs b) place the client in right sided-lying position c) place the client in semi-fowler's position d) place the client in left sided-lying position 28.
Which of the following signs and symptoms most likely are experienced by the client? Select all that apply a) pain in the left upper quadrant of the abdomen b) bile-stained vomitus c) elevated serum amylase d) hypercalcemia e) steatorrhea .d) the jejunum receives its blood supply through the duodenum 30. A patient was diagnosed to have Laennec's cirrhosis.Which of the following is appropriate nursing action when caring for the client? a) wear mask when entering the client's room b) wear gloves when caring for the client c) wear mask and gloves when performing procedures to the client d) wear gown and mask when caring for the client 34. Which of the following interventions does the nurse expect to give to a client after gastrointestinal series? a) analgesic b) laxative c) antiemetic d) sedative 32. Which of the following symptoms should be assessed first? a) inability to write b) jaundice c) increased BUN d) ascites 35. A nurse assists a physician in performing a liver biopsy. After the procedure. which of the following positions should the nurse place the patient? a) prone position b) supine position c) right side-lying position with a pillow under the puncture site d) left side-lying position with a pillow under the puncture site 36. Which of the following is not a component of nursing care for the client? a) administer morphine sulfate for pain b) administer calcium supplement as ordered c) administer digestive enzymes with each meal and snack d) administer IV therapy as ordered 33. Which of the following expected outcomes should the nurse inform the client after laparoscopic cholecystectomy? a) redness and swelling on the operative site b) serosanguinous drainage on the dressing c) shoulder pain for 24 hours d) nausea and vomiting for 24 hours 31. The client has been diagnosed to have VRE (Vancomycin-resistant enterocolitis). The client has been diagnosed to have acute pancreatitis. The client had been diagnosed to have acute pancreatitis.
The nurse is taking care of a patient with a positive clostridium difficile culture result. frequent meals f) start meal with hot foods and beverages 43. The client with liver cirrhosis has developed esophageal varices. low fat diet d) meperidine hydrochloride 50mg/IV every 4 hours 41. Which of the following should the nurse advise the client to avoid? Select all that apply a) coughing b) straining at stool c) yawning d) bending and stooping e) swallowing f) heavy lifting g) spicy foods 42. The charge nurse will intervene if she observes the nurse to be a) wearing gloves in handling secretions . The child has been diagnosed to have Hirschprung's disease (Aganglionic megacolon) by rectal biopsy. The client had undergone Billroth II surgery. high protein foods b) limit concentrated carbohydrates c) lie down in left side-lying position after meals d) take fluids with meals e) take small. Which of the following findings most likely is experienced by the child? a) ribbon-like stool b) currant jelly-like stool c) olive-sized mass in the abdomen d) sausage-like mass in the abdomen 38. Which of the following health teachings should be taken to the client before discharge? Select all that apply a) take dry. Which of the following assessment findings will the nurse expect? a) medium-pitched gurgling sounds b) high-pitched tinkling bowel sounds c) absence of bowel sounds d) increased bowel sounds 40. Which of the following physician's orders for a client with acute pancreatitis should be questioned by the nurse? a) zantac 300mg 1 tablet BID b) morphine sulfate 5mg/IV every 6 hours c) bland. The nurse assists the physician during paracentesis.f) hypoglycemia g) weight loss 37. The client had been diagnosed to have complete intestinal obstruction. In which position does the nurse place the client? a) lying position b) sitting position c) prone position d) side-lying position 39.
Which of the following would indicate that Bobby's appendix has ruptured? a) diaphoresis b) anorexia c) pain at Mc Burney's point d) relief from pain 50. Arrange in sequence the following actions when cleaning an abdominal incision. mask. A. The nurse. The client also has a rigid abdomen and a temperature of 103. during change-of-shift report should remind the next shift nurse to: a) keep scissors at bedside b) avoid instilling fluid into the aspiration port c) keep tracheostomy tray at bedside d) deflate the balloon for 15 to 30 minutes every 2 hours 47. Which is the priority complication of CAPD to be addressed in the plan of care? a) bleeding b) pain c) outflow problems d) infection Situation: Bobby. 48. gloves. and cap while giving care to the patient 44. After gastrojejunostomy. which has decreased in intensity over the last day. B. a) prepare supplies b) apply sterile gloves c) do hand washing apply clean gloves d) remove soiled dressings e) clean from the top to the bottom of the abdominal incision g) apply sterile dressings . E. A client has Sengstaken-Blakemore tube. An important nursing action to perform when preparing Bobby for an appendectomy is to: a) administer saline enemas to cleanse the bowels b) apply heat to reduce pain c) measure abdominal girth d) continuously monitor pain 49. F 46. A nurse is making a home health visit and finds the client experiencing right lower quadrant abdominal pain. The nurse should intervene by: . which of the following instructions should be included in the health teachings of the patient? a) limit carbohydrates in your diet b) increase fluid intake c) avoid lying down after eating d) limit proteins in your diet 45. D.b) washing hands before and after entering the room and giving care to the patient c) instructing the patient to wash hands with antimicrobial soap d) wearing gown. The nurse is developing the plan of care for a client receiving continuous ambulatory peritoneal dialysis (CAPD).6 F.C. a 13 year old is being seen in the emergency room for possible appendicitis.
A nurse is working in the emergency room and receives a client with suspected botulism. anticipating a laboratory report that indicates a serum amylase level of: a) 45 units/L b) 100 units/L c) 300 units/L d0 500 units/L 53. A nurse is monitoring a postoperative client after abdominal surgery for signs ofcomplications. To minimize the effects of the disorder. The nurse reviews the laboratory result.a) administering Tylenol (acetaminophen) for the elevated temperature b) advising the client to increase oral fluids c) asking the client when she last had a bowel movement d) notifying the physician 51. The nurse is assigned to a 40-year old client who has a diagnosis of chronic pancreatitis. followed by the passage of two liquid stools. A nurse notes that the client has abdominal distention as well. which is just below the upper limit of normal? a) 20 unit/L b) 80 unit/L c) 135 unit/L d) 350 unit/L 54. A client who is recently has been started on enteral feedings begins to complain of abdominal cramping. Which action is a priority for the nurse to initiate? a) administer vaccine for botulism b) initiate isolation c) induce vomiting d) administer antibiotics 52. The nurse reviews the nutritional content on the label of the can of feeding to see if it has which of the following ingredients? a) lactose b) sucrose c) fructose d) maltose 55. The nurse assesses the client for the presence of Homan's sign and determines that his sign is positive if which of the following is noted? a) incisional pain b) absent bowel sounds c) pain with dorsiflexion of the foot d) crackles on auscultation of the lungs . An adult client was diagnosed with acute pancreatitis 9 days ago. A nurse is caring for a client with cirrhosis of the liver. the nurse teaches the client about foods that are high in thiamine. The nurse interprets that the client is recovering from this episode if the serum lipase level decreases to which of the following values. The nurse determines that the client has the best understanding of the dietary measures to follow if the client states an intention to increase the intake of: a) pork b) milk c) chicken d) broccoli 56.
3. decrease skeletal muscle spasms. There is an obstruction in the common bile duct. 2.5 mg is ordered for a client having an acute attack of cholecystitis. A nurse is assessing for correct placement of a nasogastric tube. An adult client with a history of gastrointestinal bleeding has a platelet count of 300. 2. The nurse verifies correct tube placement if which pH value is noted? a) 3. 2. A client who is recovering from surgery has been advanced from a clear liquid diet to a full liquid diet. The nurse aspirates the stomach contents and checks the contents for pH.5 58. What is the primary purpose of this drug for this client? To 1. Proper nursing action in response to this should be to 1. drainage form the T tube for the first 24 hours postoperative was 350 cc.0 c) 7. decrease smooth muscle contractions 4.4 g/dL b) 3. Bile is no longer produced by the gallbladder. decrease anxiety 3. notify the physician . An adult client with cirrhosis has been following a diet with optimal amounts of protein because neither an excess or a deficiency of protein has been helpful.35 d) 7.8 g/dL 60. increase gastrointestinal peristalsis 3.4 g/dL d) 9. . 4. There is an obstruction in the pancreatic duct.5 b) 7. Following a cholecystectomy. Atropine 0. The client is looking forward to the diet change because he has been "bored" with the clear liquid diet. Which action by the nurse is most appropriate after seeing the laboratory results? a) report the abnormally low count b) report the abnormally high count c) place the client on bleeding precautions d) place the normal report in the client's medical record 59. There are gallstones in the gallbladder.57. An adult who has cholecystitis reports clay colored stools and moderate jaundice. The nurseevaluates the client's status as being most satisfactory if the total protein level in which of the following values? a) 0.7 g/dL c) 6. Which is the best explanation for the presence of clay colored stools and jaundice? 1.000 cells/mm3. The nurse would offer which full liquid item to the client? a) tea b) gelatin c) custard d) popsicle 1.
raise the level of the drainage bag to decrease rate of flow. The primary purpose for administering this drug is to reduce 1. peristaltic action in the colon. Hypokalemia. Fecal matter must be cleansed from the bowel for good visualization. 4. 8. The nurse is teaching him what to expect regarding the procedure. He reports to the nurse that he has gained 14 pounds over the last two months. 2. Hypoglycemia. Na and K 4. Which statement should be included in the teaching? 1. 9. 3. Which nursing response is best? 1. increase the IV flow rate to compensate for the loss. Encourage coughing and deep breathing. 2. 4. feces in the bowel. 3. An abdomino-perineal resection with a transverse colostomy is planned for an adult male client. Because a client has a nasogastric tube attached to intermittent drainage the nurse should be particularly alert for the development of which complication? 1. given a general anesthetic during the procedure. asked to assist by performing a Valsalva maneuver during the procedure. . 2. Neomycin sulfate p. “How did your eating habits change?” 5. 3. There will be no food restrictions before the test. 1. Hypocalcemia. Which nursing intervention is essential immediately following a gastroduodenoscopy? Force fluids. 4. A barium enema is ordered for an adult male client. 4. 3. 4. Hypermagnesemia. The nurse’s instructions should include the information that he will be 1.2. Hemoglobin and Hematocrit 2. An adult client is to have a gastroduodenoscopy in the morning. He will not have to change positions during the procedure. 2. Which of the following laboratory tests would it be most essential for the nurse to assess immediately? 1. 7. 10. asked to assist by coughing during the procedure. 4. given a local anesthetic to ease the discomfort during the procedure. 4. An adult male client is admitted with a diagnosis of probable duodenal ulcer. BUN and creatinine 6.o. is ordered prior to surgery. “Why were you eating more?” 2. 3. He will be asked to drink barium during the procedure. electrolyte imbalances. continue to observe and measure drainage. An adult male is admitted to the hospital complaining of burning epigastric pain. Instruct him not to eat or drink. “Has the weight gain been intentional?” 3. Position him supine. bacterial content in the colon. 2. “Does your weight usually fluctuate this much?” 4. 3. SGPT and SGOT 3.
Asking what time the surgeon will be in. 2. Which of the following client behaviors is indicative of a willingness to be involved in self-care following a colostomy? 1. The nurse explains to her that laxatives are not given to persons with possible appendicitis. Which of the following food lists is appropriate for him to eat on a low residue diet? 1. 4. coffee. Lettuce. The client with appendicitis will experience brief relief following this action. Bran cereal. Complaining about the noise in the adjacent room. whole wheat toast. Discussing the cost of his hospitalization. If the client has an acute inflammation she will feel localized pain in the inflamed area. “Eating three nutritious meals and snacks every day is okay. “Have you had surgery before?” 3. On the second day after admission. tea. “When did you last eat?” 2. 3. The nurse is caring for a client who has had a colostomy. 2. This procedure will create more flaccid abdominal muscles allowing easier abdominal exam. Notify the physician. corn. The client with appendicitis asks the nurse for a laxative to help relieve her constipation. apples. Examine the client for board-like rigidity of the abdomen. “I will have to drink lots of milk and cream every day.” 3. Laxatives are not given prior to any type of surgery. 2. “I will stay away from cola drinks after I am discharged. soft boiled eggs. While examining the client the physician asks her to stand on her toes and drop to her heels with a thump. 2. A young college student comes to the emergency room with nausea. “Have you ever had this type of pain before?” 4. persistent pain radiating to the shoulder. Which question is it essential to ask? 1. 3. Prunes. “What do you usually take to relieve your pain? 17. vomiting and severe abdominal pain of six hours duration. 13. The client with a duodenal ulcer is ready for discharge. 4. Administer ordered prn pain medication. What is the primary reason for this? 1. What action should the nurse take first? 1.” 4. 3. spinach. Laxatives will decrease the spread of infection. .” 2.11. Which of the following interpretations of this procedure is the most accurate? 1. Place client in a high-Fowler’s position to decrease pressure on the gastric area and shoulder. “It’s a good thing I gave up drinking alcohol last year. An irritated bowel will become less tender. Which statement made by the client indicates a need for more teaching about his diet? 1. 3. An adult is admitted with a duodenal ulcer. 2. In preparation for an abdomino-perineal resection the client is placed on a low residue diet. The nurse is admitting a client with a diagnosis of appendicitis to the surgical unit. Ground lean beef. Asking questions about the equipment being used. the client develops severe. 4. 12. 16. 4. 14. grapes.” 15.
She only has pressure. The patient does not have true constipation. Fresh peas. 3. Roast beef. What should the nurse do before irrigating the nasogastric tube? 1. 4. 4. . 21. Admitting orders include a low residue diet. An adult client is to have a sigmoidoscopy in the morning. The client asks how he contracted hepatitis A. 20. He stepped on a nail 2 weeks ago. 3. The client who has had a hemorrhoidectomy wants to know why she cannot take a sitz bath immediately upon return from the operating room. He is afraid of the dark. Aspirate and check the pH.3. 4. Heat can stimulate bowel movement too quickly after surgery. 4. 2. The nurse is preparing a client with Crohn’s disease for discharge. Which one is most likely related to hepatitis A? 1. 3. Sitting in water before the sutures are removed may cause infection. Which of the following statements most likely relates to the client’s concerns? 1. Keep him NPO for 8 hours before the examination. Instill 5 cc of normal saline and observe for development of coughing and dyspnea. Inject a small amount of air while listening with a stethoscope over the stomach for a “swoosh.” 2. What should the nurse plan to do? 1. 22. Heat applied immediately post-operatively increases the possibility of hemorrhage. Baked chicken. The pain increases after a day of activity. He ate home canned tomatoes. The nurse’s response is based upon which of the following concepts? 1. 2. 2. 2. Which statement he makes indicates he needs further teaching? 1.” 4. He donated blood 2 weeks before he got sick. Place the end of the nasogastric tube in a glass of water and observe for bubbles.” 3. Mashed potatoes. 4. 24. Which food would be contraindicated for this client? 1. 3. 3. 4.” 2. A client is admitted to the hospital with ulcerative colitis. “I realize I shall always have to monitor my diet. A client has an order for irrigation of a nasogastric tube. He reports all of the following. Order a low fat. Laxatives could cause rupture of the appendix. The pain is worse at night and aggravated in the recumbent position. Patients are generally not awake enough for several hours to safely take sitz baths. 3. 18. The mattress is uncomfortable. A client with pancreatitis tells the nurse that he fears nighttime. Administer enemas until clear this evening. Give him an enema 1 hour before the examination. “Since I have Crohn’s disease I don’t have to worry about colon cancer. 2.” 19. He ate oysters his roommate brought home from a fishing trip. low residue diet for breakfast. 4. “I understand there is a high incidence of familial occurrence with this disease. 23. “Stress can make it worse.
Nausea d. Nurse Hilary would recognize that the dietary teaching was well understood when the client tells a family member that: a. Increased GI motility d. Take a short walk c. What laboratory finding is the primary diagnostic indicator for pancreatitis? a. 4. Abdominal distention c. To immobilize the diaphragm. The one that should be reported immediately to the physician is: a. “Most people need to eat a high protein diet for 12 months after surgery” b. Production of serum albumin c. The nurse should teach the client that after every meals. Lie down at least 30 minutes After gastroscopy.25. 2. Difficulty in swallowing A client who has undergone a cholecystectomy asks the nurse whether there are any dietary restrictions that must be followed. Drink plenty of water d. The nurse should be aware that the ascites is most likely the result of increased… a. the client should… a. Elevated aspartate aminotransferase (AST) . The client has had a liver biopsy. To minimize the danger of aspiration. Pressure in the portal vein b. Clay. “Most people can tolerate regular diet after this type of surgery” Nurse Rachel teaches a client who has been recently diagnosed with hepatitis A about untoward signs and symptoms related to Hepatitis that may develop. Restlessness b. “I should not eat those foods that upset me before the surgery” c. Elevated blood urea nitrogen (BUN) b. To reduce the likelihood of bleeding A male client with a history of cirrhosis and alcoholism is admitted with severe dyspnea resulted to ascites. “I should avoid fatty foods as long as I live” d. an adaptation that indicates major complication would be: a. Interstitial osmotic pressure A client has Gastroesophageal Reflux Disease (GERD). Yellow urine c. Rest in sitting position b. Elevated serum lipase c. To facilitate full chest expansion. Nausea and vomiting b. The nurse should position him on his right side with a pillow under his rib cage. Secretion of bile salts d. 3. What is the primary reason for this position? 1.colored stools 1.
A client with inflammatory bowel disease undergoes an ileostomy. Increased intestinal motility b. c. the nurse would observe for: a. the nurse reviews the history and notes that the client had aphthous stomatitis at the time of the last visit. rather than as needed. How should the nurse interpret this finding? . To increase pepsin activity 6. To maintain a regular bowel pattern d. the nurse notes that the client's stoma appears dusky. 4. c. b. bradycardia. The nurse is assessing a client who is receiving total parenteral nutrition (TPN). 3. an early sign of peptic ulcer disease. Increased lactate dehydrogenase (LD) 2. restrict fluid intake to 1 qt (1. When assessing a client during a routine checkup. d. This is a common problem for elderly clients due to several factors related to aging. the nurse should advise the client to: a. The nurse is caring for a client who underwent a subtotal gastrectomy. hypertension. Diaphoresis 8. 5. drink liquids only between meals. c. Which of the following is one such factor? a. Aphthous stomatitisis is best described as: a. an acute stomach infection. To promote client compliance c. A 72-year-old client seeks help for chronic constipation. drink liquids only with meals. d. Which finding suggests that the client has developed hyperglycemia? a.5 b. Why are antacids administered regularly. To manage dumping syndrome. Kussmaul's respirations b.d. decreased urine output. acid indigestion. increased intracranial pressure.000 ml)/day. To keep gastric pH at 3. Increased intestinal bacteria d. When evaluating a client for complications of acute pancreatitis. a canker sore of the oral soft tissues. Decreased production of hydrochloric acid 7. On the first day after surgery. Decreased abdominal strength c. d. Increased urine output c. Decreased appetite d. b. don't drink liquids 2 hours before meals. b. to treat peptic ulcer disease? a.0 to 3.
The nurse should be concerned most with the potential for: a. The client is free from esophagitis and achalasia. "Eat a clear liquid diet for 2 days before the test. Abscesses may occur in IBD as poor nutrition causes breakdown of cells in the GI tract. A client with dysphagia is being prepared for discharge. Blood supply to the stoma has been interrupted. "Take a potent laxative the day before the test. Pain related to biliary spasms b. which nursing diagnosis takes top priority? a. The first nursing action should be to a. d. c. The client reports diminished duodenal inflammation. one form of IBD.a. Imbalanced nutrition: Less than body requirements related to biliary inflammation 14. b." b. 11. This is a normal finding 1 day after surgery. b. "Eat a low-residue diet for 2 days before the test." c. one form of IBD. 9. The client doesn't exhibit rectal tenesmus. c. b. The client has normal gastric structures. Diarrhea is the most common sign of IBD." d. d. c. hyperglycemia. An intestinal obstruction has occurred. which is accompanied by nausea and vomiting. A client with recent onset of epigastric discomfort is scheduled for an upper GI series (barium swallow). When teaching the client how to prepare for the test. 13. A client with mild diarrhea. A client had a nephrectomy 2 days ago and is now complaining of abdominal pressure and nausea. Which statement about IBD is true? a. Transmural inflammation with fistula formation occurs in ulcerative colitis. c. The physician diagnoses acute cholecystitis and cholelithiasis. Anxiety related to unknown outcome of hospitalization d. The ostomy bag should be adjusted. change the client's position. For this client. "Avoid eating or drinking anything for 6 to 8 hours before the test. Deficient knowledge related to prevention of disease recurrence c. A client is evaluated for severe pain in the right upper abdominal quadrant. b. Which outcome indicates that the client is ready for discharge? a. . insert a rectal tube. which instruction should the nurse provide? a. auscultate bowel sounds." 10. d. Bowel cancer is common in clients with a history of Crohn's disease. 12. palpate the abdomen. fever. An elderly client with Alzheimer's disease begins supplemental tube feedings through a gastrostomy tube to provide adequate calorie intake. d. and abdominal discomfort is being evaluated for inflammatory bowel disease (IBD).
the nurse should monitor closely for the development of which finding associated with a decrease in hepatic function? a. Which behavior suggests that the client is beginning to accept the change in body image? a. c. The client asks the spouse to leave the room." 16. After participating in counseling with the nurse and receiving support from the spouse. The nurse also expects to find: a. d. The client closes the eyes when the abdomen is exposed. the nurse explains that incentive spirometry will be used after surgery primarily to: a. the nurse should provide which discharge instruction? a. d. Pruritus of the arms and legs c. "Take antacids with meals. Jaundice b.b. c. and signs and symptoms of dehydration. tenderness and pain in the right upper abdominal quadrant. b. the nurse should: a. eliminate the need for nasogastric intubation. d. 17. The client avoids talking about the recent surgery. c. place the client in a private room. To prevent gastroesophageal reflux in a client with hiatal hernia. d. c. increase respiratory effectiveness. A client has a newly created colostomy. The client touches the altered body part. wear a gown when providing personal care for the client 20. severe abdominal pain with direct palpation or rebound tenderness. improve nutritional status during recovery. decrease the amount of postoperative analgesia needed. "Avoid coffee and alcoholic beverages. Nursing assessment of a client with peritonitis (acute or chronic inflammation of the peritoneum) reveals hypotension." b. rectal bleeding and a change in bowel habits. "Lie down after meals to promote digestion." d. Irritability and drowsiness 18. fluid volume excess. constipation. 19. Because the client requires enteric precautions. tachycardia. jaundice and vomiting. 15. Fatigue during ambulation d. b. While preparing a client for cholecystectomy. aspiration. . c. wear a mask when handling the client's bedpan. "Limit fluid intake with meals. d. b. When caring for a client with hepatitis B. wash the hands after touching the client." c. A client with viral hepatitis A is being treated in an acute care facility. the client decides to change the colostomy pouch unaided. b.
d. the nurse should provide which instruction? a. A client is recovering from an ileostomy that was performed to treat inflammatory bowel disease. and ranitidine (Zantac). A 35-year-old woman who is HIV-positive presents to the physician with jaundice and right upper quadrant abdominal pain. "Stop taking the drugs when your symptoms subside. 24." b. antacids. maintaining body weight. increasing fluid intake to prevent dehydration. 23. the nurse monitors for age-related changes in the GI tract." 22. reestablishing a normal bowel pattern. Before the pain becomes severe b. As seldom as possible to avoid morphine dependency 26. high-fiber diet. A hepatitis . b." c. During discharge teaching. A client with a peptic ulcer is about to begin a therapeutic regimen that includes a bland diet. The patient reports having had multiple episodes of jaundice over the past 10 years. Decrease in intestinal flora c. taking only enteric-coated medications. reporting pain relief. Dulling of nerve impulses 25. The physician orders morphine for a client who complains of postoperative abdominal pain. consuming a low-protein. whether or not the client has pain d. the nurse should consider the primary goal to be: a. wearing an appliance pouch only at bedtime. When the pain becomes severe c. A client. d.21. c. maintaining fluid balance. is admitted to an acute care facility for treatment of an acute flare-up of a chronic GI condition. when should the nurse anticipate administering morphine? a. "Avoid aspirin and products that contain aspirin. Atrophy of the gastric mucosa b." d. Which age-related change increases the risk of anemia? a. c. "Eat three balanced meals every day. When planning care for a client with a small-bowel obstruction. In addition to assessing the client for complications of the current illness. For maximum pain relief. Increase in bile secretion d. Before the client is discharged. b. Every 3 hours. age 82. the nurse should stress the importance of: a. "Increase your intake of fluids containing caffeine.
He has splenomegaly and muscle wasting in his extremities. his blood pressure is 80/40 mm Hg and his heart rate is 124/min. Which of the following substances inhibits the hormone causing her right upper quadrant pain? (A) Cholecystokinin (B) Gastrin (C) Pepsin (D) Somatostatin 29. Which of the following is the most likely diagnosis? (A) Colorectal carcinoma (B) External hemorrhoids (C) Internal hemorrhoids (D) Perianal abscess 28. nausea. He has an enlarged abdomen that is dull to percussion and positive for a fluid wave. His laboratory tests show a serum bilirubin level of 4 mg/dL and a direct bilirubin level of 0. The patient’s liver function tests are normal. What other finding would most likely be seen at presentation? (A) Ascites (B) Asterixis (C) Esophageal varices (D) Hyperpigmented skin 31. and vomiting. He appears jaundiced with multiple spider angiomas on his chest and arms. She reports that her symptoms are worse after she eats a fatty meal. but negative for HBsAb and anti-HAV IgM. Physical examination reveals an enlarged liver.3 mg/dL. On arrival. A 39-year-old white woman who suffers from polycythemia vera presents to the clinic complaining of severe and constant right upper quadrant pain over the past 2 days. An unconscious 57-year-old man is brought to the emergency department by ambulance with massive. Which of the following vessel anastomoses is responsible for the patient’s bleeding? (A) Left gastric artery and left gastric vein (B) Left gastric vein and azygos vein . Which of the following would most likely be lower than normal in this patient? (A) Albumin (B) Alkaline phosphatase (C) Bilirubin (D) Prothrombin time 27. A 45-year-old woman who presents to her physician with a 2-day history of right upper quadrant pain. The pain and bleeding are worse when she defecates. gas. A healthy 25-year-old man comes to the physician for a routine examination.panel is positive for HBsAg and anti-HBc IgM. bright red emesis. Which of the following best explains this patient’s serum and indirect bilirubin levels? (A) Extrahepatic biliary obstruction (B) Glucuronosyltransferase deficiency (C) Heme oxygenase deficiency (D) Intrahepatic biliary obstruction 30. A 35-year-old woman that is pregnant with her fourth child comes to the physician because of painful gastrointestinal bleeding for the past month.
(C) Paraumbilical vein and inferior epigastric vein (D) Portal vein and inferior vena cava 32. diffuse thickening of the gallbladder wall. A 46-year-old woman comes to the physician because of voluminous. A 43-year-old man with a 20-year history of ulcerative colitis presents to the physician with complaints of worsening bloody diarrhea. chloride of 110 mEq/L. potassium of 3. and arthralgias. and several small ulcerations with necrotic edges on both legs. progressive fatigue. Which of the following types of hepatocellular injury is commonly seen after acetaminophen overdose? (A) Acute hepatitis (B) Centrilobular necrosis (C) Fibrosis (D) Granuloma formation 36. On physical examination. Which of the following is the pathologic mechanism most likely responsible for the patient’s presentation? (A) Exudative diarrhea (B) Malabsorption (C) Motility derangement (D) Osmotic diarrhea . Which of the following conditions is consistent with these ERCP findings? (A) Cholelithiasis (B) Pancreatic carcinoma (C) Primary biliary cirrhosis (D) Primary sclerosing cholangitis 33.5 mEq/L. pruritus. Which of the following is most often associated with this patient’s condition? (A) Clostridium difficile (B) Clostridium perfringens (C) Escherichia coli (D) Staphylococcus aureus 34. finger clubbing. visual disturbances. he is found to have icteric sclera. Endoscopic retrograde cholangiopancreatography (ERCP) shows alternating strictures and dilations of the bile ducts. malodorous. and enlarged lymph nodes. Abdominal CT scan reveals a polypoid mass of the gallbladder protruding into the lumen. Practice Test For Nursing Entrance Exam about a 17-year-old girl who is being treated with antibiotics for recurrent sinus tract infections presents to the physician with intractable watery diarrhea and cramps. and bicarbonate of 18 mEq/L. The diarrhea usually abates on fasting. A 65-year-old white woman presents to the emergency department with persistent right upper quadrant pain with nausea and vomiting. Fecal analysis shows an increased stool osmolality and fat content (fecal fat excretion 32 g/ day [normal:< 7 g/day]). bulky stools. Laboratory tests show a sodium level of 149 mEq/L. This patient most likely has a history of which of the following? (A) Ascaris lumbricoides (B) Cigarette smoking (C) Gallstones (D) Schistosoma haematobium 35.
Which of the following is most likely responsible for this patient’s present symptoms? (A) Appendicitis (B) Bowel obstruction (C) Enterocolitis (D) Portal hypertension 39. A 62-year-old woman has had persistent nausea for 5 years with occasional vomiting. Although he was at the 75th percentile for both height and weight at birth. and a biopsy demonstrates welldifferentiated adenocarcinoma confined to the mucosa. Arterial blood gas analysis reveals a pH of 7. and a rectosigmoid biopsy shows a conspicuous absence of acetylcholinesterasepositive ganglion cells. This drug is administered intravenously every 2 months and produces substantial improvement in the patient’s symptoms between doses. Gastrointestinal endoscopy reveals a small area of gastric mucosa in the fundus without rugal folds. A 20-year-old man with Crohn’s disease refractory to treatment with high-dose methylprednisolone is started on therapy with infliximab. Several weeks after returning from his trip.37. an bicarbonate level of 34 mEq/L. he is currently at the 25th percentile for height and is below the 5th percentile for weight. Which of the following best describes the acid-base disturbance occurring in this patient? . the patient says that he traveled to eastern South America 1 year ago. Which of the following best describes infliximab’s mechanism of action? ( A) Acting as a partial agonist at some estrogen receptors and as an antagonist at others (B) Binding a growth factor receptor to target a cell for killing (C) Binding to and neutralizing a secreted cytokine (D) Inhibiting a fusion protein with tyrosine kinase activity 40. His parents report that he has a poor appetite and is very constipated. and partial carbon dioxide pressure of 40 mm Hg. he remembers having fever. Microscopy at that time showed chronic inflammation with the presence of Helicobacter pylori.50. weight loss. Bowel sounds are normal. diarrhea. a chimeric monoclonal antibody with antiinflammatory effects. Upper gastrointestinal endoscopy performed 5 years ago showed a pattern of gastritis.” Ultrasonography shows ascites and hepatic periportal fibrosis. and “funny looking stools. Which of the following best characterizes this patient’s neoplasm? (A) Favorable prognosis (B) Highest incidence in the United States (C) Linitis plastica (D) Metastases limited to regional lymph nodes 38. Which of the following genetic conditions is most commonly associated with this patient’s disease? (A) Cystic fibrosis (B) Down’s syndrome (C) Sickle cell disease (D) Tay-Sachs disease 41. Practice Test For Nursing Entrance Exam about a 23-year-old man who presents to the physician with abdominal distention and tenderness with no vomiting or diarrhea. Barium enema shows a narrow rectosigmoid with a dilation of the segment above the narrowing. which his parents believe are very painful. An 8-year-old boy presents to the emergency department with a 2-hour history of vomiting after eating dinner at a seafood buffet. Physical examination shows hepatosplenomegaly. A 2-month-old boy is brought to his pediatrician for a regular check-up. On questioning. His abdomen is distended. He has small bowel movements once a week. but his bowel sounds are normal and his abdomen does not appear to be tender.
She has a pet puppy. On questioning. small erythematous lesions on the palms.6o F) in a microaerophilic environment shows many comma-shaped organisms each with a single polar flagellum. The organism responsible for this patient’s sickness is thought to be associated with the possible later development of which of the following symptoms? (A) Acute renal failure and thrombocytopenia with hemolytic anemia (B) Fever. she is found to have icteric sclera. the patient states that his father passed away from colon cancer. They are concerned because the child seems to be having trouble with her vision at in low-light conditions. migratory polyarthritis. The patient is referred for a colonoscopy. the physician suspects bacterial gastroenteritis. and the patient asks how he got this. palpebral xanthomas. A 10-year-old girl living in New Jersey is brought to the physician because she has had a fever and headache accompanied by abdominal pain and bloody diarrhea. This patient is most likely infected with which of the following? (A) Cryptosporidium (B) Entamoeba histolytica (C) Giardia lamblia (D) Leishmania donovani 43. which the mother says has had diarrhea for the past week. and carditis (C) Fever. Her stool smear shows leukocytes. and splinter hemorrhages on the nail bed (D)Symmetric ascending muscle weakness beginning in the distal lower extremities 45. Based on the above information. new murmur. it is learned that the patient went swimming in a lake during a camping trip 2 days ago. Digestive Disorder Question about a 27-year-old man who goes to the doctor for an annual physical examination. A 24-year-old man presents to the physician with diarrhea and abdominal cramps.(A) Metabolic acidosis (B) Metabolic acidosis/respiratory acidosis (C) Metabolic acidosis/respiratory alkalosis (D) Metabolic alkalosis 42. She denies any history of alcohol or drug use. A stool sample is sent for laboratory evaluation. Which of the following is the inheritance pattern of this condition? (A) Autosomal dominant (B) Autosomal recessive (C) Autosomal trisomy (D) Sex chromosome abnormality 44. When asked about his family history. She has no history of recent travel or sick contacts. A 2-year-old girl who has recently been adopted from an impoverished family is brought to the clinic by her adopted parents. A diagnosis of familial adenomatous polyposis is suspected. A 46-year-old white woman with rheumatoid arthritis presents with severe pruritus. On rectal examination. The vitamin most likely deficient in this child is absorbed by the gastrointestinal system using what mechanism? (A) Apoferritin-mediated transport (B) Intrinsic factor-mediated transport (C) Micelle-mediated transport (D) Sodium-dependent cotransport 46. masses are palpated. On physical examination. and . A stool culture incubated at 42o C (107. A fecal occult blood test is positive. which reveals adenomatous polyps located diffusely throughout the colon.
Flexion at his hip elicits pain. His last blood test showed that he had elevated LDL cholesterol and triglyceride levels. On physical examination.000/mm3. A 10-year-old boy presents to the pediatrician with weight loss and multiple purpuric lesions all over his body.3° F) and a WBC count of 13. She tests positive for antimitochondrial antibody and increased alkaline phosphatase activity. Which of the following is most likely responsible for this patient’s presentation? (A) Destruction of intrahepatic bile ducts (B) Hepatic parenchymal destruction (C) Obstruction of extrahepatic bile ducts (D) Portal vein thrombosis 47. Which of the following is most likely responsible for the child’s illness? (A) Enteroinvasive Escherichia coli (B) Enterotoxigenic Escherichia coli (C) Salmonella spp. Release of manual pressure on the abdomen causes more pain than deep palpation. the causative organism is shown to be a non-lactose-fermenting and non-hydrogen sulfide-producing bacterium. Which of the following is most likely responsible for this patient’s adverse effects? (A) Intravenous immunoglobulin (B) Lamivudine (C) Pegylated interferon (D) Ribavirin 49. Which of the following is also most likely present in this patient? (A) Abdominal distention (B) Dyspnea (C) Hunger (D) Nausea and vomiting 50. Which of the following will most likely be seen on bowel biopsy? (A) Benign mucosa (B) Continuous linear mucosal lesions (C) Diffuse severe atrophy and blunting of the villi (D) Foamy macrophages in the lamina propria 48. A 4-year-old child is brought to the pediatrician because of abdominal pain. The physician decides to prescribe . greasy yellow stools associated with abdominal pain and flatulence that most often occurs after meals. (D) Shigella species 51. The patient has bulky. vomiting.5° C (101. On stool culture. A 42-year-old man visits his primary care physician to discuss possible cholesterol-lowering agents. The child has a fever of 39. and diarrhea containing mucus and blood. Digestive Disorder Question about a 26-year-old man with hepatitis C who is being medically treated while he awaits liver transplantation. One of the drugs he is taking causes him to have periodic fevers and chills and a sense of depression that he did not have prior to treatment.hepatomegaly.4° C (103° F). the patient has a temperature of 38. A 19-year-old man presents to the emergency department with a new onset of right lower quadrant abdominal pain.
5 g/dL. His laboratory studies are unremarkable except for a serum albumin level of 7. Which of the following medications is this patient most likely taking? (A) Aspirin (B) Calcium carbonate (C) Cimetidine (D) Misoprostol 55. was given ciprofloxacin. He reports a 4. and a slight increase in HDL cholesterol 52. Which of the following is the most likely risk factor for this patient’s duodenal ulcer? (A) Alcohol use (B) Chronic nonsteroidal anti-inflammatory use (C) Excessive salt intake (D) Tobacco use 53. foul-smelling stools. and a slight decrease in triglycerides (D) A large decrease in triglycerides. an increase in HDL cholesterol. vomiting. and diarrhea. a slight decrease in LDL cholesterol. He also states that every once in a while he has a few days of bulky. The patient was previously diagnosed with penicillin-sensitive Streptococcus pyogenes on throat culture and. He also says he has been admitted to the hospital several times over the past few years for the same reason. Which of the following is the most likely finding associated with this patient’s illness? (A) Abdominal air-fluid levels on x-ray (B) Abdominal free air under the right hemidiaphragm on x-ray (C) Pancreatic calcifications on computed tomography (D) Pancreatic cysts . His plasma calcium and phosphate levels are within the normal ranges. Which of the following results are likely to be seen on this patient’s next blood test? (A) A decrease in LDL cholesterol and a slight increase in triglycerides (B) A decrease in LDL cholesterol with little to no effect on HDL or triglycerides (C) A large decrease in LDL cholesterol. He has no other medical problems and takes no medications. A 33-year-old man with active gastroesophageal reflux disease returns to his physician for the second time in 2 weeks complaining of a worsening sore throat. Endoscopy reveals mucosal ulceration in the duodenal bulb. Which of the following conditions would most likely cause this patient’s laboratory abnormality? (A) Acute infection (B) Chronic liver disease (C) Dehydration (D) Nephrotic syndrome 54. A 50-year-old alcoholic man presents with intermittent “stomach” pain that also seems to be present “between his shoulder blades. the physician asks the patient if he has been taking any other medications.5-kg (10-lb) weight gain over the past 4 months. A 76-year-old man with chronic obstructive pulmonary disease presents at his annual clinic visit with complaints of black stools and epigastric pain relieved by meals. because he is allergic to penicillin.gemfibrozil and schedules the man for a follow-up visit in 1 month. Suspicious of an interaction. Digestive Disorder Question about a 20-year-old man who presents to his physician with a 2-day history of fever.” The pain is often associated with nausea and vomiting. Physical examination is unremarkable.
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