Digestive & Gastrointestinal System Disorders | NCLEX Quiz 71

1. The client being seen in a physician's office has just been scheduled for a barium swallow the next day. The nurse writes down which of the following instructions for the client to follow before the test?

Fast for 8 hours before the test

Eat a regular supper and breakfast

Continue to take all oral medications as scheduled.

Monitor own bowel movement pattern for constipation

A barium swallow is an x-ray study that uses a substance called barium for contrast to highlight abnormalities in the GI tract. The client should fast for 8 to 12 hours before the test. depending on the physician instructions. Most oral medications also are withheld before the test. After the procedure the nurse must monitor for constipation. which can occur as a result of the presence of barium in the GI tract.

Explanation

A barium swallow is an x-ray study that uses a substance called barium for contrast to highlight abnormalities in the GI tract. The client should fast for 8 to 12 hours before the test. depending on the physician instructions. Most oral medications also are withheld before the test. After the procedure the nurse must monitor for constipation. which can occur as a result of the presence of barium in the GI tract.

2. After a right hemicolectomy for treatment of colon cancer. a 57-year old client is reluctant to turn while on bed rest. Which action by the nurse would be appropriate?

Asking a coworker to help turn the client

Explaining to the client why turning is important.

Allowing the client to turn when he’s ready to do so

Telling the client that the physician’s order states he must turn every 2 hours

The appropriate action is to explain the importance of turning to avoid postoperative complications. Asking a coworker to help turn the client would infringe on his rights. Allowing him to turn when he’s ready would increase his risk for postoperative complications. Telling him he must turn because of the physician’s orders would put him on the defensive and exclude him from participating in care decision.

Explanation

The appropriate action is to explain the importance of turning to avoid postoperative complications. Asking a coworker to help turn the client would infringe on his rights. Allowing him to turn when he’s ready would increase his risk for postoperative complications. Telling him he must turn because of the physician’s orders would put him on the defensive and exclude him from participating in care decision.

3. The nurse is preparing a discharge teaching plan for the client who had an umbilical hernia repair. Which of the following would the nurse include in the plan?

Restricting pain medication

Maintaining bedrest

Avoiding coughing

Irrigating the drain

Bedrest is not required following this surgical procedure. The client should take analgesics as needed and as prescribed to control pain. A drain is not used in this surgical procedure. although the client may be instructed in simple dressing changes. Coughing is avoided to prevent disruption of the tissue integrity. which can occur because of the location of this surgical procedure.

Explanation

Bedrest is not required following this surgical procedure. The client should take analgesics as needed and as prescribed to control pain. A drain is not used in this surgical procedure. although the client may be instructed in simple dressing changes. Coughing is avoided to prevent disruption of the tissue integrity. which can occur because of the location of this surgical procedure.

4. A client has a percutaneous endoscopic gastrostomy tube inserted for tube feedings. Before starting a continuous feeding. the nurse should place the client in which position?

Semi-Fowlers

Supine

Reverse Trendelenburg

High Fowler’s

To prevent aspiration of stomach contents. the nurse should place the client in semi-Fowler’s position. High Fowler’s position isn’t necessary and may not be tolerated as well as semi-Fowler’s.

Explanation

To prevent aspiration of stomach contents. the nurse should place the client in semi-Fowler’s position. High Fowler’s position isn’t necessary and may not be tolerated as well as semi-Fowler’s.

5. In a client with diarrhea. which outcome indicates that fluid resuscitation is successful?

The client passes formed stools at regular intervals

The client reports a decrease in stool frequency and liquidity

The client exhibits firm skin turgor

The client no longer experiences perianal burning.

A client with diarrhea has a nursing diagnosis of Deficient fluid volume related to excessive fluid loss in the stool. Expected outcomes include firm skin turgor. moist mucous membranes. and urine output of at least 30 ml/hr. The client also has a nursing diagnosis of diarrhea. with expected outcomes of passage of formed stools at regular intervals and a decrease in stool frequency and liquidity. The client is at risk for impaired skin integrity related to irritation from diarrhea; expected outcomes for this diagnosis include absence of erythema in perianal skin and mucous membranes and absence of perianal tenderness or burning.

Explanation

A client with diarrhea has a nursing diagnosis of Deficient fluid volume related to excessive fluid loss in the stool. Expected outcomes include firm skin turgor. moist mucous membranes. and urine output of at least 30 ml/hr. The client also has a nursing diagnosis of diarrhea. with expected outcomes of passage of formed stools at regular intervals and a decrease in stool frequency and liquidity. The client is at risk for impaired skin integrity related to irritation from diarrhea; expected outcomes for this diagnosis include absence of erythema in perianal skin and mucous membranes and absence of perianal tenderness or burning.

6. A 30-year old client experiences weight loss. abdominal distention. crampy abdominal pain. and intermittent diarrhea after birth of her 2nd child. Diagnostic tests reveal gluten-induced enteropathy. Which foods must she eliminate from her diet permanently?

Milk and dairy products

Protein-containing foods

Cereal grains (except rice and corn)

Carbohydrates

To manage gluten-induced enteropathy. the client must eliminate gluten. which means avoiding all cereal grains except for rice and corn. In initial disease management. clients eat a high calorie. high-protein diet with mineral and vitamin supplements to help normalize nutritional status.

Explanation

To manage gluten-induced enteropathy. the client must eliminate gluten. which means avoiding all cereal grains except for rice and corn. In initial disease management. clients eat a high calorie. high-protein diet with mineral and vitamin supplements to help normalize nutritional status.

7. An enema is prescribed for a client with suspected appendicitis. Which of the following actions should the nurse take?

Prepare 750 ml of irrigating solution warmed to 100*F

Question the physician about the order

Provide privacy and explain the procedure to the client

Assist the client to left lateral Sim’s position

Enemas are contraindicated in an acute abdominal condition of unknown origin as well as after recent colon or rectal surgery or myocardial infarction. The other answers are correct only when enema administration is appropriate.

Explanation

Enemas are contraindicated in an acute abdominal condition of unknown origin as well as after recent colon or rectal surgery or myocardial infarction. The other answers are correct only when enema administration is appropriate.

8. The nurse is monitoring a client for the early signs of dumping syndrome. Which symptom indicates this occurrence?

Abdominal cramping and pain

Bradycardia and indigestion

Sweating and pallor

Double vision and chest pain

Early manifestations of dumping syndrome occur 5 to 30 minutes after eating. Symptoms include vertigo. tachycardia. syncope. sweating. pallor. palpitations. and the desire to lie down.

Explanation

Early manifestations of dumping syndrome occur 5 to 30 minutes after eating. Symptoms include vertigo. tachycardia. syncope. sweating. pallor. palpitations. and the desire to lie down.

9. The nurse is caring for a hospitalized client with a diagnosis of ulcerative colitis. Which finding. if noted on assessment of the client. would the nurse report to the physician?

Bloody diarrhea

Hypotension

A hemoglobin of 12 mg/dL

Rebound tenderness

Rebound tenderness may indicate peritonitis. Blood diarrhea is expected to occur in ulcerative colitis. Because of the blood loss. the client may be hypotensive and the hemoglobin level may be lower than normal. Signs of peritonitis must be reported to the physician.

Explanation

Rebound tenderness may indicate peritonitis. Blood diarrhea is expected to occur in ulcerative colitis. Because of the blood loss. the client may be hypotensive and the hemoglobin level may be lower than normal. Signs of peritonitis must be reported to the physician.

10. When teaching a community group about measures to prevent colon cancer. which instruction should the nurse include?

“Limit fat intake to 20% to 25% of your total daily calories.”

“Include 15 to 20 grams of fiber into your daily diet.”

“Get an annual rectal examination after age 35.”

“Undergo sigmoidoscopy annually after age 50.”

To help prevent colon cancer. fats should account for no more than 20% to 25% of total daily calories and the diet should include 25 to 30 grams of fiber per day. A digital rectal examination isn’t recommended as a stand-alone test for colorectal cancer. For colorectal cancer screening. the American Cancer society advises clients over age 50 to have a flexible sigmoidoscopy every 5 years. yearly fecal occult blood tests. yearly fecal occult blood tests PLUS a flexible sigmoidoscopy every 5 years. a double-contrast barium enema every 5 years. or a colonoscopy every 10 years.

Explanation

To help prevent colon cancer. fats should account for no more than 20% to 25% of total daily calories and the diet should include 25 to 30 grams of fiber per day. A digital rectal examination isn’t recommended as a stand-alone test for colorectal cancer. For colorectal cancer screening. the American Cancer society advises clients over age 50 to have a flexible sigmoidoscopy every 5 years. yearly fecal occult blood tests. yearly fecal occult blood tests PLUS a flexible sigmoidoscopy every 5 years. a double-contrast barium enema every 5 years. or a colonoscopy every 10 years.