PrepU CH. 29 – Flashcards
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A client is admitted to the hospital with a suspected diagnosis of strangulated bowel. The nurse anticipates the client will need:
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Surgery to release the bowel
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A nurse is teaching a client diagnosed with Crohn disease about potential complications. The most appropriate information for the nurse to include would be:
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Fistula formation
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The nurse is reviewing the medical history of four clients. The nurse determines that the client at greatest risk for developing peptic ulcer disease is:
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A client with a prior diagnosis of Helicobacter pylori and refused treatment
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Malabsorption syndrome results in loss of fat in the stool and failure to absorb fat-soluble vitamins.
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True
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After several months of persistent heartburn, a 57 year-old female client has been diagnosed with gastroesophageal reflux disease (GERD). Which of the following treatment regimens is likely to best address the woman's health problem?
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Proton pump inhibitors; avoiding large meals; remaining upright after meals
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A male patient has just been diagnosed with esophageal cancer. He knew he was losing weight and fatigued most days, but he just attributed it to aging and working. The physician recommends chemotherapy and irradiation. However, the cancer has already metastasized. The patient asks the nurse what he can expect if he agrees to the treatments. The nurse responds:
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"The therapies may shrink the cancer in an effort to increase survival of the cancer."
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A patient has recently been diagnosed with H. pylori gastritis. The nurse knows that this form of gastritis is usually treated with a combination of an antibiotic and:
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Proton pump inhibitors.
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A 22 year-old student has developed a fever and diarrhea while on a backpacking trip in Southeast Asia. His oral temperature is 101.40 F. The diarrhea is bloody, frequent, and small in volume. These clinical manifestations are sufficiently distressing that he/she is visiting a local medical clinic in the area. Which of the following diagnoses best characterizes this health problem?
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Inflammatory diarrhea
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A 71 year-old male has been recently diagnosed with a stage III tumor of colorectal cancer, and is attempting to increase his knowledge base of his diagnosis. Which of the following statements about colorectal cancer demonstrates a sound understanding of the disease?
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"While diet is thought to play a role in the development of colorectal cancer, the ultimate causes are largely unknown."
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The nurse is teaching her patient with hepatobiliary disease about her diet. She tells her that she may have steatorrhea, which is the malabsorption of which dietary component?
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Fat
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In the balance of secretions in the gastric mucosa by the parietal cells, which of the following ions is produced to buffer the production of hydrochloric acid?
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HCO3-
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Symptoms of gastric cancer include vague epigastric pain, which makes early detection difficult. The nurse would expect a patient to undergo which of the following diagnostic examinations to determine the location of the gastric cancer?
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Barium x-ray
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Crohn's disease has a distinguishing pattern in the gastrointestinal (GI) tract. The surface has granulomatous lesions surrounded by normal-appearing mucosal tissue. A complication of the pattern includes which of the following?
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Fistula formation
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A patient with a history of peptic ulcer disease presents to the emergency department with the following symptoms: early satiety, feeling of epigastric fullness and heaviness after meals, weight loss, and vomiting. The nurse suspects that the peptic ulcer has caused which of the following problems?
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Obstruction
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The incidence of stomach cancer has significantly decreased in the United States, yet it remains the leading cause of death worldwide. The nurse understands the reason for the high mortality rate in stomach cancer is because of which of the following reasons?
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Patients have few early symptoms of the disease.
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Crohn's disease is treated by several measures. Treatment with corticosteroids focuses on which of the following?
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Inflammatory suppression
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A patient is admitted with an intestinal obstruction with abdominal bloating. Which of the following types of treatment does the nurse know will help decompress the bowel?
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Nasogastric tube to suction
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Upon admission, a patient tells the nurse that he takes aspirin every 4 hours every day. The nurse determines that this patient is at risk for which of the following?
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Peptic ulcer
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Diverticulitis is the herniation of tissue of the large intestine through the muscularis layer of the colon. It is often asymptomatic and is found in approximately 80% of people over the age of 85. Diverticulitis is often asymptomatic, but when symptoms do occur, what is the most common complaint of the client?
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Lower left quadrant pain with nausea and vomiting
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After several months of persistent heartburn, a 57-year-old female client has been diagnosed with gastroesophageal reflux disease (GERD). Which treatment regimen is likely to best address the woman's health problem?
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Proton pump inhibitors; avoiding large meals; remaining upright after meals
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A client who is diagnosed with Zollinger-Ellison syndrome will exhibit which symptoms?
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Diarrhea with fat deposits
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Select the client at greatest risk for developing colorectal cancer.
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A 64-year-old female whose mother had colorectal cancer
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A nurse is reviewing the admission assessment data of a client diagnosed with acute gastritis. The nurse determines that the condition most likely occurred as a result of:
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Arthritis treated with high levels of nonsteroidal anti-inflammatory (NSAIDs) agents
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Parents of a 20-month-old infant report that he refuses food or eats poorly and that he grimaces when he swallows. He also is irritable and cries a lot. The mother is worried that he ate something inappropriate this morning, because he vomited something that looked like coffee grounds. Which of the following health problems would the care team first suspect?
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Esophagitis from gastrointestinal reflux
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Which of the following clients is most clearly displaying the signs and symptoms of irritable bowel disease (IBD)?
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A 51 year-old male who states that his stomach pain is in his lower abdomen, "comes and goes" and "feels more like a cramp than a dull ache."
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A rare condition caused by gastrin-secreting tumors most commonly found in the small intestine or pancreas is called which of the following?
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Zollinger-Ellison syndrome
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Inflammatory bowel disease (IBD) is used to designate two related inflammatory intestinal disorders: Crohn's disease and ulcerative colitis. The nurse recognizes the difference between the distribution pattern between Crohn's disease and ulcerative colitis. Which of the following patterns describes Crohn's disease?
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Skip lesions
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Crohn's disease is recognized by sharply demarcated, granulomatous lesions that are surrounded by normal-appearing mucosal tissue. The nurse recognizes these lesions to be defined by which of the following descriptions?
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Cobblestone
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The cause of gastric carcinomas has been influenced by which of the following factors? Select all that apply.
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Strain of Helicobacter pylori (H. pylori) • Environmental factors • Family history
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A patient diagnosed with ulcerative colitis has been experiencing more than six bloody stools daily with evidence of toxicity. The nurse should question which of the following orders from the physician?
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Colonoscopy
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An elderly patient has been placed on a broad-spectrum antibiotic for a recurrent urinary tract infection. Which of the following potential problems would the nurse anticipate in this patient?
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Colonization of Clostridium difficile
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An elderly patient presents with loose mucousy stools. The nurse suspects the patient has Clostridium difficile. What is a priority assessment for the nurse?
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Ask the patient about his or her antibiotic use.
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Good hand-washing techniques are important in healthcare. The nurse knows that bacterial infections can be prevented by good hand-washing techniques. Which of the following routes of transmission is most common for Clostridium difficile?
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Fecal-oral transmission
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A nurse administering a patient's medication tells the patient that a proton pump inhibitor has been added. When the patient asks the purpose of the medication, the nurse responds that it is to prevent which of the following?
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Stress ulcer
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A nurse reading a sigmoidoscopy report notes that a patient was found to have skip lesions. The nurse interprets this as an indication of which of the following?
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Crohn's disease
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A nurse caring for a patient with an intestinal obstruction anticipates which of the following assessment findings? Select all that apply.
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Abdominal pain Abdominal distension Vomiting
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A client tells the doctor that every time he eats something made with wheat, barley, and/or rye, he gets sick. The doctors suspects the client has celiac sprue. The physician should further assess the client for: Select all that apply.
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Diarrhea Abdominal pain Iron deficiency
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Crohn disease is a recurrent inflammatory disease that can affect any area of the bowel. Characteristic of Crohn disease are granulomatous lesions that are sharply demarcated from the surrounding tissue. The nurse caring for a client with newly diagnosed Crohn disease would know to include what in the teaching?
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Information on sulfasalazine including dosage, route, frequency, and side effects of the drug
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A 68-year-old man who has smoked for at least 50 years reports that lately he feels as though food is "getting stuck" in his throat. At first this was a problem just with dry food, but now his morning oatmeal is getting stuck. On questioning, he reports drinking at least five alcoholic beverages nearly every day. His problem is most likely:
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squamous cell carcinoma of the esophagus.
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A 79-year-old woman reports a recent onset of "nearly constant heartburn." During the assessment interview, she states that she has "lots of aches and pains." She states that she is not on any prescription medications but often takes aspirin for pain. The nurse should suspect what diagnosis?
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Acute gastritis
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A client has developed a ruptured appendix. The nurse is aware the client is at high risk for:
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Peritonitis
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Constipation is the infrequent or difficult passage of stools.
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True
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The nurse walks into a room and finds the patient forcefully expelling stomach contents into a wash basin. When documenting this occurrence, the nurse will use the term:
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Vomiting.
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A 28-year-old man presents with complaints of diarrhea, fecal urgency, and weight loss. His stool is light-colored and malodorous, and it tends to float and be difficult to flush. He has also noted tender, red bumps on his shins and complains of pain and stiffness in his elbows and knees. Sigmoidoscopy reveals discontinuous, granulomatous lesions; no blood is detected in his stool. Which of the following diagnoses would his care team first suspect?
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Crohn disease
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A patient is admitted with a peptic ulcer. The nurse's priority on admission is to assess for which of the following? Select all that apply.
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Smoking history • Family history • Alcohol usage
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The patient who has experienced third-degree burns is susceptible to which of the following specific types of gastrointestinal (GI) ulceration?
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Stress
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A nurse has just completed the assessment of a client diagnosed with inflammatory diarrhea who is having multiple small stools that are bloody and has a fever. The client asks the nurse what is causing the diarrhea. The best response by the nurse would be:
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C. difficile
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A client is admitted to the emergency department with early symptoms of appendicitis. The nurse would assess the client for:
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Vague pain that is referred to the epigastric or periumbilical area
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A 43 year-old male client has presented to the emergency department with vomiting that he claims is of a sudden onset. The client also states that the emesis has often contained frank blood in the hours prior to admission. His vital signs are stable with temperature 98.30 F, pulse 88, BP 140/87, and respiratory rate 18. Which of the following potential contributing factors would the health care team suspect first?
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Alcohol consumption
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A 20 year-old woman has visited her family physician due to occasional bouts of bloody diarrhea over the past several weeks, a phenomenon that she experienced two years prior as well. Her physician has diagnosed her with ulcerative colitis based on her history and visualization of the affected region by colonoscopy and sigmoidoscopy. Which of the following pathophysiological phenomena is most likely to underlie the client's health problem?
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Mucosal hemorrhages that have developed into crypt abscesses, which have in turn necrotized and ulcerated.
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The nurse is caring for a patient with chronic diarrhea. She knows that this condition could be caused by which of the following? Select all that apply.
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Crohn disease, Ulcerative colitis, Lactase deficiency, and Fecal impaction.
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Which symptom is often observed in cases of peritonitis?
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Abdominal rigidity
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Treatment for Helicobacter pylori (H. pylori) requires combination therapy that includes which of the following medications? Select all that apply.
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Bismuth salts Omeprazole Amoxicillin
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Crohn's disease not only affects adults but also can occur in children. The nurse assesses for which of the following major manifestations in children with Crohn's disease?
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Malnutrition
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An older patient presents with a perforation of a peptic ulcer. The nurse will monitor for signs and symptoms of which of the following problems?
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Peritonitis
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A patient is diagnosed with Crohn's disease. The nurse instructs the patient on which of the following types of dietary needs?
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High-calorie, vitamin, and protein diet
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A patient complains of having bouts of diarrhea. The patient wants to know which antidiarrheal would be best to use. Which of the following antidiarrheals does the nurse know will help stimulate water and electrolyte absorption?
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Diphenoxylate (Lomotil)
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A patient is admitted with an abrupt onset of referred pain to the epigastric area, with an episode of nausea. On the nurse's initial assessment, the patient is lying still and taking shallow breaths, with a rigid abdomen. Which of the following problems is the patient experiencing?
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Peritonitis
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A patient is being screened for colorectal cancer with the fecal occult test. The nurse instructs the patient to avoid ingesting which of the following 3-7 days prior to the test? Select all that apply.
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Aspirin Citrus fruits Red meats
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A patient is admitted with chronic gastritis. The nurse expects which of the following invasive tests to be performed to establish the presence of Helicobacter pylori (H. pylori)?
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Endoscopic biopsy
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A nurse is completing a history and physical assessment on a patient admitted with ulcerative colitis. Which of the following symptoms would the nurse anticipate? Select all that apply.
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Diarrhea Rectal bleeding
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The nurse is teaching the client about dietary factors that increase risks for colon cancer. The most important information for the nurse to include would be: Select all that apply.
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"Increasing your daily amount of sugar intake does influence your risk." "Decrease your daily intake of vitamins A and E."
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Irritable bowel syndrome is thought to be present in 10% to 15% of the population in the United States. What is its hallmark symptom?
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Abdominal pain relieved by defecation with a change in consistency or frequency of stools
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A 40-year-old man tells the nurse that his father died of gastric cancer and that he wants to do everything he can do to avoid the disease. Which recommendation should the physician provide?
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Avoid smoked and preserved foods
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A young man presents reporting diarrhea, fecal urgency, and weight loss. His stool is light-coloured and malodorous, and it tends to float and be difficult to flush. He has also noted tender, red bumps on his shins and reports pain and stiffness in his elbows and knees. Sigmoidoscopy reveals discontinuous, granulomatous lesions; no blood is detected in his stool. Which diagnosis would his care team first suspect?
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Crohn disease
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A stroke patient is having difficulty swallowing food and beverages. The patient complains that it feels like "the food is sticking to the back of their throat." Given this information, the priority nursing interventions would be to:
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Make the patient "nothing per os" (NPO) and call the physician.
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Following a history of gastric pain and an endoscopy, a client has been diagnosed with a duodenal peptic ulcer. Which of the following teaching points should his caregiver provide?
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"Your family history, your smoking history and NSAID use may all have contributed to this problem."
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Parents have brought their seven year old child into the emergency room with abdominal pain. Which of the following clinical manifestations would lead the healthcare team to suspect the child has appendicitis? Select all that apply.
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Tenderness in right lower quadrant with palpation.• Rebound tenderness in inguinal areas with palpation.
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The mother of a 19 week-old infant has brought her baby in for assessment to a pediatrician because of the baby's persistent weight loss and diarrhea. An intestinal biopsy has confirmed a diagnosis of celiac disease, and the child's mother is anxious to know what caused the disease. Which of the following aspects of the etiology of celiac disease would underlie the explanation that the physician provides?
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An inappropriate T-cell mediated response results in increased levels of antibodies and an inflammatory response.
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When comparing the symptomology of Crohn disease with that of ulcerative colitis, which symptoms are generally characteristic of only Crohn disease? Select all that apply.
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Fistulas. Perianal ulcers.
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A patient presents with a perforated peptic ulcer. Which of the following complications would be a priority for the nurse?
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Assessment of a rigid, boardlike abdomen
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Peptic ulcers can affect one or all layers of the stomach or duodenum. Ulcers that penetrate through the muscularis layer are classified as which of the following types of ulcer?
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Perforation
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A patient is admitted to the medical surgical unit with a history of inflammatory bowel disease. The nurse knows that the clinical manifestations of both Crohn's disease and ulcerative colitis are the result of activation of which of the following cells?
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Inflammatory
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A physician's orders for a patient to be started on total parenteral nutrition (TPN). The nurse knows that TPN is a hypertonic solution and must be administered in which of the following ways?
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Through a large diameter central line
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Celiac disease commonly presents in infancy as failure to thrive. It is an inappropriate T-cell-mediated immune response, and there is no cure for it. What is the treatment of choice for celiac disease?
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Removal of gluten from the diet
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A busy 45-year-old female executive has been diagnosed with diverticulitis. Her primary treatment is an increase in the fibre content of her diet. What effect will the fibre have on the diverticula?
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The fibre increases bulk, promotes regular defecation, and increases colonic contents and colon diameter, thereby decreasing intraluminal pressure.
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The nurse has been providing dietary teaching to a client diagnosed with irritable bowel syndrome. The nurse determines that the teaching was effective when the client selects:
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A bran muffin, fruit, and orange juice.
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The nurse is assessing a client who has just developed peritonitis. The nurse would expect the client to manifest:
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A board-like abdomen
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The nurse is teaching an adult client about home treatment for uncomplicated diarrhea. The most appropriate information for the nurse to provide would be:
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Oral replacement therapy (ORT)
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A number of clients on a geriatric subacute medical floor of a hospital have developed foul-smelling diarrhea over the last several days, and subsequent culture of stool samples has confirmed the presence of Clostridium difficile in each case. The care team on the unit would recognize that which of the following factors likely contributed to the health problem and would anticipate which of the following treatments?
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The use of broad spectrum antibiotics likely played a role in the developments of the infections, and most clients would likely receive metronidazole as a treatment.
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A client has been admitted to the hospital with an exacerbation of peptic ulcer disease. The nurse is aware the client is at risk for: Select all that apply.
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Perforation • Hemorrhage • Obstruction
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Diarrhea is described as a change in frequency of stool passage to a point where it is excessively frequent. Diarrhea can be acute or chronic, inflammatory, or noninflammatory. What are the symptoms of noninflammatory diarrhea? (Select all that apply.)
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Nonbloody stools, periumbilical cramps, and nausea and/or vomiting
