Digestive & Gastrointestinal System Disorders | NCLEX Quiz 84

1. During preparation for bowel surgery. a male client receives an antibiotic to reduce intestinal bacteria. Antibiotic therapy may interfere with synthesis of which vitamin and may lead to hypoprothrombinemia?

Vitamin A

Vitamin D

Vitamin E

Vitamin K

Intestinal bacteria synthesize such nutritional substances as vitamin K. thiamine. riboflavin. vitamin B12. folic acid. biotin. and nicotinic acid. Therefore. antibiotic therapy may interfere with synthesis of these substances. including vitamin K. Intestinal bacteria don’t synthesize vitamins A. D. or E.

Explanation

Intestinal bacteria synthesize such nutritional substances as vitamin K. thiamine. riboflavin. vitamin B12. folic acid. biotin. and nicotinic acid. Therefore. antibiotic therapy may interfere with synthesis of these substances. including vitamin K. Intestinal bacteria don’t synthesize vitamins A. D. or E.

2. Which one do you like?

Lying on the right side with legs straight

Lying on the left side with knees bent

Prone with the torso elevated

Bent over with hands touching the floor

For a colonoscopy. the nurse initially should position the client on the left side with knees bent. Placing the client on the right side with legs straight. prone with the torso elevated. or bent over with hands touching the floor wouldn’t allow proper visualization of the large intestine.

Explanation

For a colonoscopy. the nurse initially should position the client on the left side with knees bent. Placing the client on the right side with legs straight. prone with the torso elevated. or bent over with hands touching the floor wouldn’t allow proper visualization of the large intestine.

3. The nurse is caring for a male client with cirrhosis. Which assessment findings indicate that the client has deficient vitamin K absorption caused by this hepatic disease?

Dyspnea and fatigue

Ascites and orthopnea

Purpura and petechiae

Gynecomastia and testicular atrophy

A hepatic disorder. such as cirrhosis. may disrupt the liver’s normal use of vitamin K to produce prothrombin (a clotting factor). Consequently. the nurse should monitor the client for signs of bleeding. including purpura and petechiae. Dyspnea and fatigue suggest anemia. Ascites and orthopnea are unrelated to vitamin K absorption. Gynecomastia and testicular atrophy result from decreased estrogen metabolism by the diseased liver.

Explanation

A hepatic disorder. such as cirrhosis. may disrupt the liver’s normal use of vitamin K to produce prothrombin (a clotting factor). Consequently. the nurse should monitor the client for signs of bleeding. including purpura and petechiae. Dyspnea and fatigue suggest anemia. Ascites and orthopnea are unrelated to vitamin K absorption. Gynecomastia and testicular atrophy result from decreased estrogen metabolism by the diseased liver.

4. A male client is recovering from a small-bowel resection. To relieve pain. the physician prescribes meperidine (Demerol). 75 mg I.M. every 4 hours. How soon after administration should meperidine onset of action occur?

5 to 10 minutes

15 to 30 minutes

30 to 60 minutes

2 to 4 hours

Meperidine’s onset of action is 15 to 30 minutes. It peaks between 30 and 60 minutes and has a duration of action of 2 to 4 hours.

Explanation

Meperidine’s onset of action is 15 to 30 minutes. It peaks between 30 and 60 minutes and has a duration of action of 2 to 4 hours.

5. A male client with pancreatitis complains of pain. The nurse expects the physician to prescribe meperidine (Demerol) instead of morphine to relieve pain because:

Meperidine provides a better. more prolonged analgesic effect.

Morphine may cause spasms of Oddi’s sphincter.

Meperidine is less addictive than morphine.

Morphine may cause hepatic dysfunction.

For a client with pancreatitis. the physician will probably avoid prescribing morphine because this drug may trigger spasms of the sphincter of Oddi (a sphincter at the end of the pancreatic duct). causing irritation of the pancreas. Meperidine has a somewhat shorter duration of action than morphine. The two drugs are equally addictive. Morphine isn’t associated with hepatic dysfunction.

Explanation

For a client with pancreatitis. the physician will probably avoid prescribing morphine because this drug may trigger spasms of the sphincter of Oddi (a sphincter at the end of the pancreatic duct). causing irritation of the pancreas. Meperidine has a somewhat shorter duration of action than morphine. The two drugs are equally addictive. Morphine isn’t associated with hepatic dysfunction.

6. Which of the following nursing interventions should the nurse perform for a female client receiving enteral feedings through a gastrostomy tube?

Change the tube feeding solutions and tubing at least every 24 hours.

Maintain the head of the bed at a 15-degree elevation continuously.

Check the gastrostomy tube for position every 2 days.

Maintain the client on bed rest during the feedings.

Tube feeding solutions and tubing should be changed every 24 hours. or more frequently if the feeding requires it. Doing so prevents contamination and bacterial growth. The head of the bed should be elevated 30 to 45 degrees continuously to prevent aspiration. Checking for gastrostomy tube placement is performed before initiating the feedings and every 4 hours during continuous feedings. Clients may ambulate during feedings.

Explanation

Tube feeding solutions and tubing should be changed every 24 hours. or more frequently if the feeding requires it. Doing so prevents contamination and bacterial growth. The head of the bed should be elevated 30 to 45 degrees continuously to prevent aspiration. Checking for gastrostomy tube placement is performed before initiating the feedings and every 4 hours during continuous feedings. Clients may ambulate during feedings.

7. A male client with extreme weakness. pallor. weak peripheral pulses. and disorientation is admitted to the emergency department. His wife reports that he has been "spitting up blood." A Mallory-Weiss tear is suspected. and the nurse begins taking a client history from the client's wife. The question by the nurse that demonstrates her understanding of Mallory-Weiss tearing is:

“Tell me about your husband’s alcohol usage.”

“Is your husband being treated for tuberculosis?”

“Has your husband recently fallen or injured his chest?”

“Describe spices and condiments your husband uses on food.”

A Mallory-Weiss tear is associated with massive bleeding after a tear occurs in the mucous membrane at the junction of the esophagus and stomach. There is a strong relationship between ethanol usage. resultant vomiting. and a Mallory-Weiss tear. The bleeding is coming from the stomach. not from the lungs as would be true in some cases of tuberculosis. A Mallory-Weiss tear doesn’t occur from chest injuries or falls and isn’t associated with eating spicy foods.

Explanation

A Mallory-Weiss tear is associated with massive bleeding after a tear occurs in the mucous membrane at the junction of the esophagus and stomach. There is a strong relationship between ethanol usage. resultant vomiting. and a Mallory-Weiss tear. The bleeding is coming from the stomach. not from the lungs as would be true in some cases of tuberculosis. A Mallory-Weiss tear doesn’t occur from chest injuries or falls and isn’t associated with eating spicy foods.

8. Which one do you like?

Increased intracranial pressure.

Decreased urine output.

Bradycardia.

Hypertension.

Acute pancreatitis can cause decreased urine output. which results from the renal failure that sometimes accompanies this condition. Intracranial pressure neither increases nor decreases in a client with pancreatitis. Tachycardia. not bradycardia. usually is associated with pulmonary or hypovolemic complications of pancreatitis. Hypotension can be caused by a hypovolemic complication. but hypertension usually isn’t related to acute pancreatitis.

Explanation

Acute pancreatitis can cause decreased urine output. which results from the renal failure that sometimes accompanies this condition. Intracranial pressure neither increases nor decreases in a client with pancreatitis. Tachycardia. not bradycardia. usually is associated with pulmonary or hypovolemic complications of pancreatitis. Hypotension can be caused by a hypovolemic complication. but hypertension usually isn’t related to acute pancreatitis.

9. Which condition is most likely to have a nursing diagnosis of fluid volume deficit?

Appendicitis

Pancreatitis

Cholecystitis

Gastric ulcer

Hypovolemic shock from fluid shifts is a major factor in acute pancreatitis. The other conditions are less likely to exhibit fluid volume deficit.

Explanation

Hypovolemic shock from fluid shifts is a major factor in acute pancreatitis. The other conditions are less likely to exhibit fluid volume deficit.

10. While a female client is being prepared for discharge. the nasogastric (NG) feeding tube becomes cloggeD. To remedy this problem and teach the client's family how to deal with it at home. what should the nurse do?

Irrigate the tube with cola.

Advance the tube into the intestine.

Apply intermittent suction to the tube.

Withdraw the obstruction with a 30-ml syringe.

The nurse should irrigate the tube with cola because its effervescence and acidity are suited to the purpose. it’s inexpensive. and it’s readily available in most homes. Advancing the NG tube is inappropriate because the tube is designed to stay in the stomach and isn’t long enough to reach the intestines. Applying intermittent suction or using a syringe for aspiration is unlikely to dislodge the material clogging the tube but may create excess pressure. Intermittent suction may even collapse the tube.

Explanation

The nurse should irrigate the tube with cola because its effervescence and acidity are suited to the purpose. it’s inexpensive. and it’s readily available in most homes. Advancing the NG tube is inappropriate because the tube is designed to stay in the stomach and isn’t long enough to reach the intestines. Applying intermittent suction or using a syringe for aspiration is unlikely to dislodge the material clogging the tube but may create excess pressure. Intermittent suction may even collapse the tube.