GI and Hematology exam 5: Which stool

GI and Hematology exam 5: Which stool characteristic should the nurse expect to note from a client with Chron’s disease? Chronic constipation Diarrhea Alteration of diarrhea and constipation ***wrong answer Constant oozing from the rectum A client has a nasal gastric tube (NGT) inserted. Before using the tube, which of the following is most important? Confirm the type of feeding that will be initiated Identify the weight of the patient Confirm placement before initiating feedings by installing air in the abdomen and listening for the “swish” sound Obtain a radiographic exam to confirm non-respiratory placement of the tube A client is scheduled to have a barium enema. Which statement by the client indicates proper understanding of the pre-procedure instructions? “I will need to eat a low fiber diet 2 days before the test.” “I do not have to be NPO since this procedure does not involve my upper GI system.” “I can eat anything I want the day of the procedure as long as I drink the barium 30 minutes before the procedure” “I will need to take a preparation to cleanse my bowels.” Ordered: Ancef 0.375g IM q6hr, Available: Ancef 500 mg/2 ml How many ml with the nurse administer in 24 hours? 6 ml 0.375g=375 mg/500 mg x’s 2 ml x’s 4 Which of the following statements from the client diagnosed with diverticulitis demonstrates understanding of disease management? “I will need to avoid alcoholic beverages” “I should lay down after eating meals.” “I should eliminate strawberries, seeds, nuts and corn from my diet” “I will need to take an antacid daily” A client is worrying about gas build up in his colostomy. Which foods would the nurse advise the client to avoid or prevent gas? Beans Fish Bananas Chocolate Metoclopramide (Regian) is prescribed for a client who suffers from GERD. The nurse accurately explains the action of this drug by saying which statement? “It helps to promote movement in the esophagus.” “It acts as an antacid to reduce gastric acidity” “It decreases the time food and fluids are in the stomach” “It has a local anesthetic effect on the lower esophagus” The nurse is caring for a 78 y/o who is diagnosed with acute viral gastroenteritis with diarrhea. Which of the following would be the nurse’s priority assessment? Temperature Skin integrity Color of stool Lab values***wrong answer A client has been ordered Zantac (ranitidine) 75 mg PO BID for the management of GERD. Available is Zantac 150 mg per tablet. How many tablets will the client receive over 24 hours? 1 tablet 75mg/150 mg = .5 tablet x’s 2 = 1 tablet A client with cirrhosis is exhibiting asterixis and noted increase spreading of jaundice. What is the priority of care? Abdominal girth measurement Maintenance of a low protein diet Safety precautions and cognitive assessment Fluid restriction A patient has been diagnosed with GERD. Which of the following factors increases manifestations of GERD? Sodium Milk Meat products Tight, restrictive clothing The client with gastroenteritis is being discharged from the emergency room? which of the following statements by the client indicates an understanding of the discharge teaching? “I will call the doctor if I have diarrhea or constipation” “I will need to take steroids for the rest of my life” “I should wash my hands before I eat or cook any food” “I should avoid smoking; it will make my problem worse” Which statement by the client supports the diagnosis of a gastric ulcer? “I have bright red rectal bleeding after a bowel movement” “I get pain in my stomach about 30 minutes after I eat, so I don’t eat much” “After I eat a big meal, I get pain in my right side so bad I double over” “If I lay down after eating a meal, I get a burning in my chest” Which diagnostic test would be best to confirm the diagnosis of peptic ulcer disease? EGD MRI Gastric acid stimulation Fecal occult blood The nurse determines more teaching is required when a client poet gastric bypass surgery state which of the following? “I should have well balanced meals” “I should have small frequent meals throughout the day” “I will need to have B-12 injections” “I should limit myself to (2) two large meals a day? A client has a newly created colostomy and is reluctant to participate in self-care of colostomy. Which of the following is the nurse’s best response? Insist that the client becomes involved Allow care to be deferred to the client’s family member Provide a mirror for the client to observe the stoma Assess the client for readiness to learn Which of the following statements from a client is consistent with the diagnosis of duodenal ulcer? “I have stomach pain before I eat and in the middle of the night” “I have been vomiting blood” “Food makes my stomach hurt” “When I eat certain types of food my stomach hurts” A client is diagnosed with a gastric ulcer and has been prescribed sucralfate (Carafate). Which statement by the client indicates a good understanding of the mechanism of the medication? “I have to drink 8 ounces of water before taking my medicine” “I should take my medicine before meals so I can tolerate my meals” “I need to take my medicine before meals so I can tolerate my meals” “I only need to take my medicine when I eat spicy food” The nurse is discussing dietary modifications with a client diagnosed with lower esophageal sphincter dysfunction. Which menu selection indicates the client understands the diet restrictions? One piece of fish, buttered carrots, and a cup of pudding for a snack Four pieces of fried chicken, mashed potatoes with gravy and water C. A large pepperoni pizza, green salad and coffee Tortillas with hot sauce, three bean and cheese enchiladas and tea A client is suffering from gastritis and is complaining of epigastric discomfort. Which nursing intervention will provide the greatest relief? Administer an antacid Encourage the client to eat large meals Administer a narcotic Place client in a supine position The nurse is caring for a client who has an active upper GI bleed. What is the appropriate diet for this client? NPO Clear liquids Regular Skim milk Non-pharmacologic management of GERD includes which of the following? Weight reduction: Wrong answer High calorie, high fat diet Lying down and resting after meals Drinking large amounts of fluid with meals A client who underwent a colonoscopy returns to the nursing unit, BP 140/80 pulse 78, RR 20. When the nurse returns later to reassess the client. The client is lethargic BP 110/60 Pulse weak at 70, RR 12. The nurse makes which interpretation of these assessment findings? The client needs to eat The client is just tired, and the body is adjusting to the relief of the anxiety related to the procedure The client needs rehydration treatment The client experiencing adverse effect from the analgesic given for the procedure ***wrong answer A nurse is preparing to flush a gastric tube. Which of the following steps are included in this procedure? Select all that apply Position client supine or flat in bed Insert tip of syringe into the end of the gastric tube and slowly instill flushing solution (water) Perform hand hygiene and apply clean gloves Identify client and explain procedure A patient is admitted for vomiting blood for 12 hours. What test should the nurse anticipate being ordered? Endoscopic retrograde cholangiopancreatography (ERCP) Upper GI radiographic series Barium enema Xray The nurse is caring for a client with an upper GI bleed. Which is the priority actions the nurse tales when caring for this patient? (Select all that apply) Review CBC results Be sure the patient has a large bore IV line Prepare to infuse 0.9% normal saline solution of lactated ringers Provide client with a full liquid diet Prepare for NG tube insertion 28. An 18-year-old client presents with severe abdominal pain in the RLQ and nausea. The nurse also notes that the client’s WBC count 20,000 and abdomen is rigid. Which action is most appropriate for the nurse? a. Have the client’s blood redrawn to check WBC level b. Prepare the client for surgery c. Administer antibiotic d. Administer an antiemetic 29. The provider orders Lansoprazole (Prevacid) 30 mg PO TID. The pharmacy provides Prevacid 15 mg per tablet. How many tablets will the client expected to receive in 24 hrs? A. 6 tablets B. 3 tablets C. 30 tablets D. 15 tablets 30. A nurse is caring for a client who has had diarrhea for the past 10 days. When assessing the client, the nurse would expect to find which of the following clinical manifestations? Select all that apply a. Hypertension b. Poor skin turgor c. Dry mucous membranes d. Tachycardia 31. The student nurse is caring for a patient who is receiving ismolite feedings continuously via a nasal gastric tube. The supervising nurse intervenes when the student does which of the following? a. Flushes the tube with 30 ml of water between medications b. Places the client supine before stopping the tube feedings c. Obtains a sample of gastric secretions d. Performs a GI assessment 32. What is the most likely cause of gastritis? a. History of alcohol abuse b. High carbohydrate diet c. Vegetarian diet d. Recent course of oral penicillin 33. Which of the following beverages should the nurse caution a client with peptic ulcer to avoid? a. Alcoholic beverage b. Water c. Apple juice d. Lemonade 34. The nurse notes the following when assessing a client’s new colostomy, postoperative day one. Stoma large, beefy red, draining small amount of stool. What is the nurse’s appropriate response to the assessment findings? a. Notify the surgeon b. Reassure the client that the color will improve in 2-3 days c. Document as a normal finding d. Irrigate the colostomy 35. client is being treated with blood transfusion therapy. During the first 15 minutes of the transfusion the client becomes severely short of breath and c/o itching. The transfusion is stopped the next intervention by the nurse should be: A. Administer lasix B. Draw labs C. Return the blood and the blood tubing to the blood bank D. Flush the IV line with NS 36. A client is to receive a transfusion of red blood cells. The nurse should obtain which of the following intravenous (IV) solutions to infuse with the blood? A. 0.9 normal saline B. 5%6 dextrose in 0.45% sodium chloride C. 5% dextrosé in 0.995 normal saline D. 5% dextrose in Lactated Ringers 37. Upon your assessment of a female client, you find multiple bruises (ecchymoses) and a purple rash on the chest and arms. Which of the following lab results would most likely explain the assessment findings? A. Platelet 10.000 B. HCT 42 C. HGB 18 D. WBC 11.000 38. A client with leukemia should be monitored for which of the following symptoms: A. Flu-like symptoms, fever and weakness B. Decreased urine output and sore throat C. Fever, red flushed skin and dehydration D. Lethargy and shortness of breath 39. The client received a blood transfusion. The client’s temperature is 100.6 F orally. Which of the following is the appropriate nursing action: A. Begin the transfusion and recheck the temperature in 15 mins B. Delay hanging the blood and notify the healthcare provide C. Administer an antihistamine and begin the transfusion D. Administer two tablets (650 mg) of acetaminophen and begin the transfusion immediately 40. While caring for the client with Sickle Cell Anemia, which of the following is the priority for the nurse? A. Administer pain medicine as ordered B. Draw CBC C. Provide time for client to rest D. Encourage green leafy vegetables 41. Once receiving blood from the blood bank the nurse has how long before beginning the transfusion? A. 30 minutes B. 1 hour C. 2 hours D. 3 hours 42. Which of the following clients has the highest risk for the development of folic acid deficiency anemia? A. An alcoholic B. An athlete C. A diabetic D. A teenager 43. Before beginning a blood transfusion after checking the blood with another nurse, the nurse should be sure to check which of the following? A. Vital Signs B. Skin color C. Urinary output D. Electrolyte levels 44. the nurse has just received a unit of packed red blood cells from the blood bank for transfusion. The nurse knows to select tubing that is manufactured with: A. An air vent B. An in-line filter C. A micro drip chamber D. Tinted tubing to protect the blood from light 45. which of the following laboratory results would indicate iron deficiency anemia? A. Elevated hemoglobin level B. Decreased reticulocyte count C. Elevated red blood cell count D. Red blood cell that are microcytic and hypochromic 46. A client is receiving a blood transfusion of 300ml of packed red blood cells (PRBC) at 100ml/hr. The nurse started the transfusion at 1300. What time will the transfusion be completed? Answer must be written in military time 47. A client asked, “Will I be able to live a normal life now that I have a colostomy?” What is the nurse most appropriate reply? A. “I think you should speak to the surgeon about your concerns.” B. “I’m going to have someone with a colostomy come and speak with you.” C. “You will learn how to live with it.” D. “Tell me the specific questions that you have about your life with a colostomy.” 48. client complains of nausea, chills, and severe abdominal pain that radiates to the right shoulder. The nurse assessment of the client finds the client to be tachycardia and having a fever. The nurse suspects which diagnosis: A. Cholecystitis B. Crohn’s disease C. Pancreatitis D. Appendicitis 49. A client has been receiving tube feedings via the nasal gastric tube for the last 4 hours at 65 ml/hr. Which of the following would require an intervention from the nurse? A. Distended abdomen B. Complaints of abdominal fullness C. Residual of 520 ml D. Bowel sounds present in all 4 quadrants 50. A client is receiving intermittent bolus feedings by way of a nasogastric tube. Which of the following should the nurse instruct the unlicensed personal to perform before providing the client incontinent care? A. Assist the client to a Semi-Fowler’s position B. Pause the tube feeding C. Assist the client to lateral position D. Decrease the rate of the tube feeding 51. A nurse is preparing to administer medications to a client by way of a nasogastric (NG) tube. Before administering the medication, the nurse must first. A. Check the patient’s apical pulse B. Check for tube placement C. Check the last time that medications were given D. Check when the last feeding was given 52. The nurse should be sure to instruct the client with diverticulitis to do which of the following? A. Eliminate strawberries and corn from your diet B. Avoid alcoholic beverages C. Consume a high calorie, high fat diet D. Take you antacid daily 52. The nurse is monitoring the intake of a client. 500ml of IV fluid is infusing at 100ml/hr. Three hours into the infusion the client is also placed on a regular diet alone with fluids. The client has 4z of coffee, 10oz of chocolate pudding, 8oz of cottage cheese, and 20oz of apple juice. What is the client’s total intake? 53 When discharging a client diagnosed with lower Gl bleed a nurse should teach the client that which of the following are signs of lower Gl bleed? A. Black bowel movement B. Blood in the urine C. Dark urine D. Bloody sputum. 54. Which nursing interventions should the nurse be sure to implement to prevent aspiration in client receiving tube feedings? (Select all that apply) A. Keep the HOB at 45 degrees or higher B. Liquefy tube feedings C. Provide water flushes as ordered D. Assess client’s level of consciousness 55. Which of the following are appropriate nursing interventions for a client diagnosed with sickle cell anemia? Select all that apply A. Check peripheral pulses B. Check capillary refill C. Keep room temperature below 70 degrees Fahrenheit D. Administer oxygen 56. Which of the following statements by a client diagnosed with ulcerative colitis would require an immediate response by the nurse? A. “I am having frequent loose stools’ B. “I have developed a high fever and severe abdominal pain this morning” C. This is a depression disease’ D. I think I got this disease from my father 57. Which of the following is a common GI concern of the older client? A. Constipation B. Diarrhea C. Increase appetite D. Gastric ulcers 58. Which of the following assessment findings of a 41-year-old client should a nurse consider as a risk factor for bowel disease? A. The client’s 62-year-old father died from colorectal cancer B. The client’s step cousin has inflammatory bowel disease C. The client reports eating red meat twice a week D. The client has a BMI of 24.8 59. A client has a platelet count of 18,000. What intervention should the nurse include in the plan of care? A. Institute isolation precautions B. Institute bleeding precautions C. Obtain temperatures rectally only D. Medications should be given intramuscular (IM) as often as possible 60. client diagnosed with disseminated intravascular coagulopathy (DIC) is receiving Heparin. The family member questions the medication. The nurse best response is? A. “I am just following the doctor’s orders” B. “I will have you speak with the doctor” C. “The medication will help stop the bleeding that is occuring” D. “The medication is given to stop the abnormal clotting in the capillaries and arterioles” 61. Which of the following Laboratory test results would be most helpful to the nurse in the assessment of a client with a bleeding disorder? A. Electrolytes B. Platelets C. Hemoglobin D. White Blood Cells 62. regarding the administration of liquid oral iron supplement, which of the following should the nurse be sure to do? A. Provide the client with a straw to take medication B. Administer after meals C. Administer with milk D. Instruct the client to hold medication in mouth for a few seconds before swallowing 63. client has an order for 1000 mL of LR over 8 hours. The drop factor is 20 gtt/mL. How many Gtt/ min should the client receive? 42 GTT/ML 60 x 8= 480) 1000ml/480x20gtt= 41.66 (42gtt/ml) 64. The client is to receive Metronidazole (Flagyl) 500mg in 100ml of 0.995 NS to infuse over 30 minutes. What is the mi/hr? A. 200ml B. 100 ml C. 25ml D. 50 ml 65. A clinical manifestation of autoimmune thrombocytopenic purpura is: a. Increased platelet levels b. Ecchymoses c. Increased Hct and Hgb d. Decreased WBC’s 15. Once receiving blood from SCIENCE HEALTH SCIENCE NURSING NURS 323

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