Digestive & Gastrointestinal System Disorders | NCLEX Quiz 89

1. When planning home care for a client with hepatitis A. which preventive measure should be emphasized to protect the client's family?

Keeping the client in complete isolation

Using good sanitation with dishes and shared bathrooms

Avoiding contact with blood-soiled clothing or dressing

Forbidding the sharing of needles or syringes

Hepatitis A is transmitted through the fecal oral route or from contaminated water or food. Measures to protect the family include good handwashing. personal hygiene and sanitation. and use of standard precautions. Complete isolation is not required. Avoiding contact with blood-soiled clothing or dressings or avoiding the sharing of needles or syringes are precautions needed to prevent transmission of hepatitis B.

Explanation

Hepatitis A is transmitted through the fecal oral route or from contaminated water or food. Measures to protect the family include good handwashing. personal hygiene and sanitation. and use of standard precautions. Complete isolation is not required. Avoiding contact with blood-soiled clothing or dressings or avoiding the sharing of needles or syringes are precautions needed to prevent transmission of hepatitis B.

2. Jordin is a client with jaundice who is experiencing pruritus. Which nursing intervention would be included in the care plan for the client?

Administering vitamin K subcutaneously

Applying pressure when giving I.M. injections

Decreasing the client’s dietary protein intake

Keeping the client’s fingernails short and smooth

The client with pruritus experiences itching. which may lead to skin breakdown and possibly infection from scratching. Keeping his fingernails short and smooth helps prevent skin breakdown and infection from scratching. Applying pressure when giving I.M. injections and administering vitamin K subcutaneously are important if the client develops bleeding problems. Decreasing the client’s dietary intake is appropriate if the client’s ammonia levels are increased.

Explanation

The client with pruritus experiences itching. which may lead to skin breakdown and possibly infection from scratching. Keeping his fingernails short and smooth helps prevent skin breakdown and infection from scratching. Applying pressure when giving I.M. injections and administering vitamin K subcutaneously are important if the client develops bleeding problems. Decreasing the client’s dietary intake is appropriate if the client’s ammonia levels are increased.

3. A nursing intervention for a patient with hepatitis B would include which of the following types of isolation.

Universal precautions

Blood transfusions

Enteric isolation

Strict isolation

Universal precautions are indicated for the patient with hepatitis B. Hepatitis B is contracted via blood and blood products. body secretions. and punctures from contaminated needles.

Explanation

Universal precautions are indicated for the patient with hepatitis B. Hepatitis B is contracted via blood and blood products. body secretions. and punctures from contaminated needles.

4. Marie. a 51-year-old woman. is diagnosed with cholecystitis. Which diet. when selected by the client. indicates that the nurse's teaching has been successful?

4-6 small meals of low-carbohydrate foods daily

High-fat. high-carbohydrate meals

Low-fat. high-carbohydrate meals

High-fat. low protein meals

For the client with cholecystitis. fat intake should be reduced. The calories from fat should be substituted with carbohydrates. Reducing carbohydrate intake would be contraindicated. Any diet high in fat may lead to another attack of cholecystitis.

Explanation

For the client with cholecystitis. fat intake should be reduced. The calories from fat should be substituted with carbohydrates. Reducing carbohydrate intake would be contraindicated. Any diet high in fat may lead to another attack of cholecystitis.

5. 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 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 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.

6. Which of the following laboratory values would be the most important to monitor for a patient with pancreatic cancer?

Serum glucose

Radioimmunoassay (RIA)

Creatine phosphokinase (CPK)

Carcinoembryonic antigen (CEA)

In pancreatitis. hypersecretion of the insulin from a tumor may affect the islets of Langerhans. resulting in hyperinsulinemia. a complication of pancreatic cancer. Options B and D. should also be monitored to measure the effects of therapy. but hypoglycemia may be life-threatening. Creatine phosphokinase is an enzyme that reflects normal tissue catabolism. Elevated serum levels indicate trauma to cells with high CPK content. CPK and CPK-isoenzymes are used to detect a myocardial infarction.

Explanation

In pancreatitis. hypersecretion of the insulin from a tumor may affect the islets of Langerhans. resulting in hyperinsulinemia. a complication of pancreatic cancer. Options B and D. should also be monitored to measure the effects of therapy. but hypoglycemia may be life-threatening. Creatine phosphokinase is an enzyme that reflects normal tissue catabolism. Elevated serum levels indicate trauma to cells with high CPK content. CPK and CPK-isoenzymes are used to detect a myocardial infarction.

7. The hospital administrator had undergone percutaneous transhepatic cholangiography. which assessment finding indicates complication after the operation?

Fever and chills

Hypertension

Bradycardia

Nausea and diarrhea

Septicemia is a common complication after a percutaneous transhepatic cholangiography. Evidence of fever and chills. possibly indicative of septicemia. is important. Hypotension. not hypertension. is associated with septicemia. Tachycardia. not bradycardia. is most likely to occur. Nausea and diarrhea may occur but are not classic signs of sepsis.

Explanation

Septicemia is a common complication after a percutaneous transhepatic cholangiography. Evidence of fever and chills. possibly indicative of septicemia. is important. Hypotension. not hypertension. is associated with septicemia. Tachycardia. not bradycardia. is most likely to occur. Nausea and diarrhea may occur but are not classic signs of sepsis.

8. For a client in hepatic coma. which outcome would be the most appropriate?

The client is oriented to time. place. and person.

The client exhibits no ecchymotic areas.

The client increases oral intake to 2.000 calories/day.

The client exhibits increased serum albumin level.

Hepatic coma is the most advanced stage of hepatic encephalopathy. As hepatic coma resolves. improvement in the client’s level of consciousness occurs. The client should be able to express orientation to time. place. and person. Ecchymotic areas are related to decreased synthesis of clotting factors. Although oral intake may be related to level of consciousness. it is more closely related to anorexia. The serum albumin level reflects hepatic synthetic ability. not level of consciousness.

Explanation

Hepatic coma is the most advanced stage of hepatic encephalopathy. As hepatic coma resolves. improvement in the client’s level of consciousness occurs. The client should be able to express orientation to time. place. and person. Ecchymotic areas are related to decreased synthesis of clotting factors. Although oral intake may be related to level of consciousness. it is more closely related to anorexia. The serum albumin level reflects hepatic synthetic ability. not level of consciousness.

9. You observe changes in mentation. irritability. restlessness. and decreased concentration in a patient with cancer of the liver. Hepatic encephalopathy is suspected and the patient is ordered neomycin enemas. Which of the following information in the patient's history would be a contraindication of this order?

Left nephrectomy

Glaucoma in both eyes

Myocardial infarction

Peripheral neuropathy

Neomycin prevents the release of ammonia from the intestinal bacteria flora and from the breakdown of red blood cells. Common side-effects of this drug are nephrotoxicity and ototoxicity. Patients with renal disease or renal impairment should not take this drug. Peripheral neuropathy (Option D) is a chronic complication of diabetes mellitus. Options B and C are not affected by neomycin.

Explanation

Neomycin prevents the release of ammonia from the intestinal bacteria flora and from the breakdown of red blood cells. Common side-effects of this drug are nephrotoxicity and ototoxicity. Patients with renal disease or renal impairment should not take this drug. Peripheral neuropathy (Option D) is a chronic complication of diabetes mellitus. Options B and C are not affected by neomycin.

10. A patient is admitted with lacerated liver as a result of blunt abdominal trauma. Which of the following nursing interventions would NOT be appropriate for this patient?

Monitor for respiratory distress.

Monitor for coagulation studies.

Administer pain medications as ordered.

Administer normal saline. crystalloids as ordered.

Pain medication may mask signs and symptoms of hemorrhage. further decrease blood pressure. and interfere with assessment of neurologic status and additional abdominal injury.

Explanation

Pain medication may mask signs and symptoms of hemorrhage. further decrease blood pressure. and interfere with assessment of neurologic status and additional abdominal injury.