Lewis Med Surg - Upper and Lower GI Nclex Practice Questions Flashcards Quizlet PDF

Preview

Summary

Gastrointestinal study guide practice test, Lewis Med Surg - Upper and Lower GI Nclex Practice Questions Flashcards Quizlet...

Description

St dy sets, textbooks, questions Science / Medicine / Surgery

Lewis Med Surg - Upper and Lower GI NCLEX Practice Questions Terms in this set (25) A 61-year-old patient with suspected bowel

B. 8:00 AM, 12:00 PM, and 4:00 PM

obstruction had a nasogastric tube inserted at 4:00 AM. The nurse shares in the morning report that the

A nasogastric tube should be checked for patency routinely at 4-hour intervals.

day shift staff should check the tube for patency at

Thus if the tube were inserted at 4:00 AM, it would be due to be checked at 8:00

what times?

AM, 12:00 PM, and 4:00 PM.

A. 7:00 AM, 10:00 AM, and 1:00 PM B. 8:00 AM, 12:00 PM, and 4:00 PM C. 9:00 AM and 3:00 PM D. 9:00 AM, 12:00 PM, and 3:00 PM

A 72-year-old patient was admitted with epigastric

D. Rigid abdomen and vomiting following indigestion

pain due to a gastric ulcer. Which patient assessment warrants an urgent change in the

A rigid abdomen with vomiting in a patient who has a gastric ulcer indicates a

nursing plan of care?

perforation of the ulcer, especially if the manifestations of perforation appear suddenly. Midepigastric pain is relieved by eating, drinking water, or antacids with

A. Chest pain relieved with eating or drinking water

duodenal ulcers, not gastric ulcers. Back pain 3-4 hours after a meal is more likely

B. Back pain 3 or 4 hours after eating a meal

to occur with a duodenal ulcer. Burning epigastric pain 1-2 hours after a meal is an

C. Burning epigastric pain 90 minutes after

expected manifestation of a gastric ulcer related to increased gastric secretions

breakfast

and does not cause an urgent change in the nursing plan of care.

D. Rigid abdomen and vomiting following indigestion

After administering a dose of promethazine

B. Drowsiness

(Phenergan) to a patient with nausea and vomiting, what common temporary adverse effect of the

Although being given to this patient as an antiemetic, promethazine also has

medication does the nurse explain may be

sedative and amnesic properties. For this reason, the patient is likely to experience

experienced?

drowsiness as an adverse effect of the medication. Tinnitus, reduced hearing, and loss of balance are not side effects of promethazine.

A. Tinnitus B. Drowsiness C. Reduced hearing D. Sensation of falling

After the nurse teaches a patient with

C. "I will have to use herbal teas instead of caffeinated drinks."

gastroesophageal reflux disease (GERD) about recommended dietary modifications, which

Rationale: Patients with gastroesophageal reflux disease should avoid foods (such

statement by the patient indicates that the teaching

as tea and coffee) that decrease lower esophageal pressure. Patients should also

has been effective?

avoid milk, especially at bedtime, as it increases gastric acid secretion. Patients may eat spicy foods, unless these foods cause reflux. Small, frequent meals help

A. "I can have a glass of low-fat milk at bedtime."

prevent overdistention of the stomach, but patients should avoid late evening

B. "I will have to eliminate all spicy foods from my

meals and nocturnal snacking.

diet." C. "I will have to use herbal teas instead of caffeinated drinks." D. "I should keep something in my stomach all the time to neutralize the excess acids."

Lewis Med Surg - Upper and Lower GI NCLEX Practice Questions

A female patient has a sliding hiatal hernia. What nursing interventions will prevent the symptoms of

C. Have the patient eat 4 to 6 smaller meals each day.

heartburn and dyspepsia that she is experiencing?

Eating smaller meals during the day will decrease the gastric pressure and the symptoms of hiatal hernia. Keeping the patient NPO or in a Trendelenberg position

A. Keep the patient NPO.

are not safe or realistic for a long period of time for any patient. Varying antacids

B. Put the bed in the Trendelenberg position.

will only be done with the care provider's prescription, so this is not a nursing

C. Have the patient eat 4 to 6 smaller meals each

intervention.

day. D. Give various antacids to determine which one works for the patient.

Following administration of a dose of

C. Relief of nausea and vomiting

metoclopramide (Reglan) to the patient, the nurse determines that the medication has been effective when what is noted?

Metoclopramide is classified as a prokinetic and antiemetic medication. If it is effective, the patient's nausea and vomiting should resolve. Metoclopramide does not affect blood pressure, muscle tremors, or diarrhea.

A. Decreased blood pressure B. Absence of muscle tremors C. Relief of nausea and vomiting D. No further episodes of diarrhea

Following bowel resection, a patient has a

C. Reposition the tube and check for placement.

nasogastric (NG) tube to suction, but complains of nausea and abdominal distention. The nurse

The tube may be resting against the stomach wall. The first action by the nurse

irrigates the tube as necessary as ordered, but the

(since this is intestinal surgery and not gastric surgery) is to reposition the tube and

irrigating fluid does not return. What should be the

check it again for placement. The physician does not need to be notified unless the

priority action by the nurse?

tube function cannot be restored by the nurse. The patient does not have bowel sounds, which is why the NG tube is in place. The NG tube would not be removed

A. Notify the physician.

and replaced unless it was no longer in the stomach or the obstruction of the tube

B. Auscultate for bowel sounds.

could not be relieved.

C. Reposition the tube and check for placement. D. Remove the tube and replace it with a new one.

The nurse determines that a patient has

C. Epigastric pain

experienced the beneficial effects of therapy with famotidine (Pepcid) when which symptom is

Famotidine is an H2-receptor antagonist that inhibits parietal cell output of HCl

relieved?

acid and minimizes damage to gastric mucosa related to hyperacidity, thus

A. Nausea

dysphagia.

relieving epigastric pain. Famotidine is not indicated for nausea, belching, and B. Belching C. Epigastric pain D. Difficulty swallowing

Lewis Med Surg - Upper and Lower GI NCLEX Practice Questions

The nurse is caring for a 68-year-old patient admitted with abdominal pain, nausea, and

D. High-pitched and hyperactive above the area of obstruction

vomiting. The patient has an abdominal mass, and a

Early in intestinal obstruction, the patient's bowel sounds are hyperactive and high-

bowel obstruction is suspected. The nurse

pitched, sometimes referred to as "tinkling" above the level of the obstruction. This

auscultating the abdomen listens for which type of

occurs because peristaltic action increases to "push past" the area of obstruction.

bowel sounds that are consistent with the patient's

As the obstruction becomes complete, bowel sounds decrease and finally

clinical picture?

become absent.

A. Low-pitched and rumbling above the area of obstruction B. High-pitched and hypoactive below the area of obstruction C. Low-pitched and hyperactive below the area of obstruction D. High-pitched and hyperactive above the area of obstruction

The nurse is caring for a postoperative patient with

D. "This will reduce the amount of HCl in the stomach until the nasogastric tube is

a colostomy. The nurse is preparing to administer a

removed and you can eat a regular diet again."

dose of famotidine (Pepcid) when the patient asks why the medication was ordered since the patient

Famotidine is an H2-receptor antagonist that inhibits gastric HCl secretion and thus

does not have a history of heartburn or

minimizes damage to gastric mucosa while the patient is not eating a regular diet

gastroesophageal reflux disease (GERD). What

after surgery. Famotidine does not prevent air from accumulating in the stomach or

response by the nurse would be the most

stop the stomach from bleeding. Heartburn is not a side effect of general

appropriate?

anesthesia.

A. "This will prevent air from accumulating in the stomach, causing gas pains." B. "This will prevent the heartburn that occurs as a side effect of general anesthesia." C. "The stress of surgery is likely to cause stomach bleeding if you do not receive it." D. "This will reduce the amount of HCl in the stomach until the nasogastric tube is removed and you can eat a regular diet again."

The nurse is planning care for a 68-year-old patient

B. History of colorectal polyps

with an abdominal mass and suspected bowel obstruction. Which factor in the patient's history

A history of colorectal polyps places this patient at risk for colorectal cancer. This

increases the patient's risk for colorectal cancer?

tissue can degenerate over time and become malignant. Osteoarthritis, lactose intolerance, and the use of herbs do not pose additional risk to the patient.

A. Osteoarthritis B. History of colorectal polyps C. History of lactose intolerance D. Use of herbs as dietary supplements

The nurse is preparing to administer a dose of

D. Increases peristalsis by stimulating nerves in the colon wall

bisacodyl (Dulcolax). In explaining the medication to the patient, the nurse would explain that it acts in

Bisacodyl is a stimulant laxative that aids in producing a bowel movement by

what way?

irritating the colon wall and stimulating enteric nerves. It is available in oral and

A. Increases bulk in the stool

and stool softeners soften feces, and saline and osmotic solutions cause fluid

B. Lubricates the intestinal tract to soften feces

retention in the intestinal tract.

suppository forms. Fiber and bulk forming drugs increase bulk in the stool; water

C. Increases fluid retention in the intestinal tract D. Increases peristalsis by stimulating nerves in the colon wall

Lewis Med Surg - Upper and Lower GI NCLEX Practice Questions

The nurse should administer an as-needed dose of magnesium hydroxide (MOM) after noting what

B. No bowel movement for 3 days

information while reviewing a patient's medical

MOM is an osmotic laxative that produces a soft, semisolid stool usually within 15

record?

minutes to 3 hours. This medication would benefit the patient who has not had a

A. Abdominal pain and bloating

bloating, decreased appetite, or signs of hypomagnesemia.

bowel movement for 3 days. MOM would not be given for abdominal pain and B. No bowel movement for 3 days C. A decrease in appetite by 50% over 24 hours D. Muscle tremors and other signs of hypomagnesemia

The nurse would question the use of which

D. Magnesium hydroxide (Milk of Magnesia)

cathartic agent in a patient with renal insufficiency? Milk of Magnesia may cause hypermagnesemia in patients with renal insufficiency. A. Bisacodyl (Dulcolax)

The nurse should question this order with the health care provider. Bisacodyl,

B. Lubiprostone (Amitiza)

lubiprostone, and cascara sagrada are safe to use in patients with renal

C. Cascara sagrada (Senekot)

insufficiency as long as the patient is not currently dehydrated.

D. Magnesium hydroxide (Milk of Magnesia)

A patient complains of nausea. When administering

A. Tremors

a dose of metoclopramide (Reglan), the nurse should teach the patient to report which potential

Extrapyramidal side effects, including tremors and tardive dyskinesias, may occur

adverse effect?

as a result of metoclopramide (Reglan) administration. Constipation, double vision, and numbness in fingers and toes are not adverse effects of metoclopramide.

A. Tremors B. Constipation C. Double vision D. Numbness in fingers and toes

The patient receiving chemotherapy rings the call

Ondansetron is a 5-HT3 receptor antagonist antiemetic that is especially effective

bell and reports the onset of nausea. The nurse

in reducing cancer chemotherapy-induced nausea and vomiting. Morphine sulfate

should prepare an as-needed dose of which

may cause nausea and vomiting. Zolpidem does not relieve nausea and vomiting.

medication?

Dexamethasone is usually used in combination with ondansetron for acute and chemotherapy-induced emesis.

A. Morphine sulfate B. Zolpidem (Ambien) C. Ondansetron (Zofran) D. Dexamethasone (Decadron)

A patient reports having a dry mouth and asks for

D. Promethazine (Phenergan)

something to drink. The nurse recognizes that this symptom can most likely be attributed to a

A common adverse effect of promethazine, an antihistamine/antiemetic agent, is

common adverse effect of which medication that

dry mouth; another is blurred vision. Common side effects of digoxin are yellow

the patient is taking?

halos and bradycardia. Common side effects of cefotetan are nausea, vomiting, stomach pain, and diarrhea. Common side effects of famotidine are headache,

A. Digoxin (Lanoxin)

abdominal pain, constipation, or diarrhea.

B. Cefotetan (Cefotan) C. Famotidine (Pepcid) D. Promethazine (Phenergan)

Lewis Med Surg - Upper and Lower GI NCLEX Practice Questions

The patient who is admitted with a diagnosis of diverticulitis and a history of irritable bowel disease

B. Heartburn

and gastroesophageal reflux disease (GERD) has

Mylanta is an antacid that contains both aluminum and magnesium. It is indicated

received a dose of Mylanta 30 mL PO. The nurse

for the relief of GI discomfort, such as heartburn associated with GERD. Mylanta

should evaluate its effectiveness by questioning the

can cause both diarrhea and constipation as a side effect. Mylanta does not affect

patient as to whether which symptom has been

lower abdominal pain.

resolved? A. Diarrhea B. Heartburn C. Constipation D. Lower abdominal pain

A patient with a history of peptic ulcer disease has

A. Providing IV fluids and inserting a nasogastric (NG) tube

presented to the emergency department reporting severe abdominal pain and has a rigid, boardlike

A perforated peptic ulcer requires IV replacement of fluid losses and continued

abdomen that prompts the health care team to

gastric aspiration by NG tube. Nothing is given by mouth, and gastric pH testing is

suspect a perforated ulcer. What intervention

not a priority. Calcium gluconate is not a medication directly relevant to the

should the nurse anticipate?

patient's suspected diagnosis, and parenteral nutrition is not a priority in the short term.

A. Providing IV fluids and inserting a nasogastric (NG) tube B. Administering oral bicarbonate and testing the patient's gastric pH level C. Performing a fecal occult blood test and administering IV calcium gluconate D. Starting parenteral nutrition and placing the patient in a high-Fowler's position

The patient with chronic gastritis is being put on a

C. Antibiotic(s), proton pump inhibitor, and bismuth

combination of medications to eradicate H. pylori. Which drugs does the nurse know will probably be

To eradicate H. pylori, a combination of antibiotics, a proton pump inhibitor, and

used for this patient?

possibly bismuth (for quadruple therapy) will be used. Corticosteroids, aspirin, and NSAIDs are drugs that can cause gastritis and do not affect H. pylori.

A. Antibiotic(s), antacid, and corticosteroid B. Antibiotic(s), aspirin, and antiulcer/protectant C. Antibiotic(s), proton pump inhibitor, and bismuth D. Antibiotic(s) and nonsteroidal antiinflammatory drugs (NSAIDs)

A stroke patient who primarily uses a wheelchair for

A. Fecal impaction

mobility has diarrhea with fecal incontinence. What should the nurse assess first?

Patients with limited mobility are at risk for fecal impactions due to constipation that may lead to liquid stool leaking around the hardened impacted feces, so

A. Fecal impaction

assessing for fecal impaction is the priority. Perineal hygiene can be assessed at

B. Perineal hygiene

the same time. Assessing the dietary fiber and fluid intake and antidiarrheal agent

C. Dietary fiber intake

use will be assessed and considered next.

D. Antidiarrheal agent use

Lewis Med Surg - Upper and Lower GI NCLEX Practice Questions

Two days following a colectomy for an abdominal mass, a patient reports gas pains and abdominal

A. impaired peristalsis.

distention. The nurse plans care for the patient

Until peristalsis returns to normal following anesthesia, the patient may experience

based on the knowledge that the symptoms are

slowed gastrointestinal motility leading to gas pains and abdominal distention.

occurring as a result of

Irritation of the bowel, nasogastric suctioning, and inflammation of the surgical site do not cause gas pains or abdominal distention.

A. impaired peristalsis. B. irritation of the bowel. C. nasogastric suctioning. D. inflammation of the incision site.

B. How to deep breathe and cough What information would have the highest priority to be included in preoperative teaching for a 68-yearold patient scheduled for a colectomy?

Because anesthesia, an abdominal incision, and pain can impair the patient's respiratory status in the postoperative period, it is of high priority to teach the patient to cough and deep breathe. Otherwise, the patient could develop

A. How to care for the wound

atelectasis and pneumonia, which would delay early recovery from surgery and

B. How to deep breathe and cough

hospital discharge. Care for the wound and location and care of the drains will be

C. The location and care of drains after surgery

briefly discussed preoperatively, but done again with higher priority after surgery.

D. Which medications will be used during surgery

Knowing which drugs will be used during surgery may not be meaningful to the patient and should be reviewed with the patient by the anesthesiologist.