Chapter 20 My Nursing Test Banks

Tabloski Gerontological Nursing, 3/e
Chapter 20

Question 1

Type: MCSA

An older resident is complaining of being constipated. Which action should the nurse take first when caring for this patient?

1. Assess the diet for adequacy of fiber and fluids.

2. Determine what the patient means by constipation.

3. Obtain an order for a laxative and an enema if needed.

4. Encourage the patient to increase fluid intake and activity.

Correct Answer: 2

Rationale 1: Assessing the diet for adequacy of fiber and fluids might be appropriate after the nurse determines how the patient defines constipation.
Reference: Page 574

Rationale 2: The nurse should first carefully evaluate the patients concern and question the person as to what is considered as being constipation. Determining the patients normal frequency of bowel movement, consistency of stool, and effort in passing stool is important before deciding to act.
Reference: Page 574

Rationale 3: Obtaining an order for a laxative and enema might be appropriate after the nurse determines how the patient defines constipation.
Reference: Page 574

Rationale 4: Encouraging the patient to increase fluid intake and activity might be appropriate after the nurse determines how the patient defines constipation.
Reference: Page 574

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Basic Care and Comfort

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 2. Recognize the impact of age-related changes on gastrointestinal function.

Question 2

Type: MCMA

After an assessment the nurse is concerned that an older patient is at risk for liver cancer. What did the nurse assess in this patient?

Standard Text: Select all that apply.

1. History of colon polyps

2. Diagnosis of diverticulitis

3. 50 year history of smoking

4. History of hepatitis B infection

5. Previous treatment for alcoholism

Correct Answer: 3,4,5

Rationale 1: A history of colon polyps is not a risk factor for liver cancer.
Reference: Page 579

Rationale 2: A diagnosis of diverticulitis is not a risk factor for liver cancer.
Reference: Page 579

Rationale 3: Smoking is a predisposing factor for liver cancer.
Reference: Page 579

Rationale 4: History of hepatitis B infection is a risk factor for liver cancer.
Reference: Page 579

Rationale 5: Excessive alcohol intake is a predisposing factor for liver cancer.
Reference: Page 579

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 3. Identify risk factors to health for the older person with gastrointestinal problems.

Question 3

Type: MCSA

An older patient is experiencing diarrhea. Which assessment finding supports that the patients diarrhea is caused by Clostridium difficile?

1. The patient has a history of ulcerative colitis.

2. The patient has been taking prescribed steroids for several months.

3. The patient recently completed a course of antibiotics for pneumonia.

4. The patient rarely eats fresh fruits and vegetables and self-restricts fluid intake.

Correct Answer: 3

Rationale 1: A history of ulcerative colitis would not necessarily be associated with Clostridium difficile.
Reference: Page 572

Rationale 2: Steroid use is not associated with the development of a Clostridium difficile infection.
Reference: Page 572

Rationale 3: Clostridium difficile can be the cause of diarrhea in an older patient who has recently completed antibiotic use.
Reference: Page 572

Rationale 4: A diet poor in fresh fruits and vegetables and limited fluid intake would contribute to the development of constipation and not diarrhea caused by Clostridium difficile.
Reference: Page 572

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4. Interpret unique presentations of gastrointestinal problems in the older person.

Question 4

Type: MCSA

Which gastrointestinal change in an older patient does the nurse recognize as being associated with aging?

1. Decreased esophageal motility

2. Decreased incidence of cholelithiasis

3. Increase in hydrochloric acid in the stomach

4. Increased absorption of nutrients in the intestines

Correct Answer: 1

Rationale 1: Changes in the gastrointestinal system that occur with the aging process include a decrease in esophageal motility.
Reference: Page 558

Rationale 2: Older patients experience an increase in the occurrence of cholelithiasis (gallstones).
Reference: Page 558

Rationale 3: There is a decrease in the amount of hydrochloric acid in the stomach with aging.
Reference: Page 558

Rationale 4: A lessening of nutrient absorption occurs in the intestines with aging.
Reference: Page 558

Global Rationale:

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 1. Describe age-related changes that affect gastrointestinal function.

Question 5

Type: MCMA

Which interventions should the nurse use to reduce the risk of aspiration for an older patient with dysphagia?

Standard Text: Select all that apply.

1. Monitor during meals for a change in respirations.

2. Maintain an upright position for 1 hour after eating.

3. Raise the head of the bed to a 90 degree angle during meals.

4. Provide pureed solid foods and thin clear liquids during meals.

5. Ensure that one bite has been swallowed before providing another.

Correct Answer: 1,2,3,5

Rationale 1: An intervention to reduce the risk of aspiration in an older patient with dysphagia is to monitor the patient during meals for a change in respirations. This could indicate that the patient is aspirating food or fluids.
Reference: Page 561

Rationale 2: An intervention to reduce the risk of aspiration in an older patient with dysphagia is to maintain the patient in an upright position for 1 hour after eating.
Reference: Page 561

Rationale 3: An intervention to reduce the risk of aspiration in an older patient with dysphagia is to raise the head of the bed to a 90 degree angle during meals.
Reference: Page 561

Rationale 4: Offer food and liquid consistencies according to the speech pathologists and dietitians recommendations. Pureed foods and thin liquids could encourage aspiration.
Reference: Page 561

Rationale 5: An intervention to reduce the risk of aspiration in an older patient with dysphagia is to ensure that one bite has been swallowed before providing another.
Reference: Page 561

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Basic Care and Comfort

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 6. Formulate and implement appropriate nursing interventions to care for the older person with gastrointestinal problems.

Question 6

Type: MCSA

The nurse instructs a family member on how to feed an older patient. Which observation indicates that the family member needs additional instruction?

1. Checks to make sure the patients dentures are in place

2. Makes sure that each bite is swallowed before providing the next bite

3. Reminds the patient to chew the food after being placed in the patients mouth

4. Tries to insert a utensil in the patients mouth and the patient bites down tightly

Correct Answer: 4

Rationale 1: The family member should ensure that the patients dentures are in place and in good repair.
Reference: Page 561

Rationale 2: Patients being fed must be given time to swallow what is in the mouth before being fed another bite.
Reference: Page 561

Rationale 3: Focusing attention on the task at hand and verbally reinforcing the expected activity may prove effective when feeding the patient.
Reference: Page 561

Rationale 4: The nurse should reinforce that forceful feeding techniques should not be used. Family members may feel frustrated if the patient does not cooperate with eating. Forcing the issue will likely lead to more power struggles at mealtime and the patient may simply not feel like eating.
Reference: Page 561

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Basic Care and Comfort

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 6. Formulate and implement appropriate nursing interventions to care for the older person with gastrointestinal problems.

Question 7

Type: MCSA

Which assessment finding should the nurse realize as being a cause for gastroesophageal reflux disease (GERD) occurring more commonly in older adults?

1. Increased amounts of saliva

2. Increased incidence of hiatal hernia

3. Tightening of the lower esophageal sphincter

4. The increase in peristalsis that occurs in the esophagus

Correct Answer: 2

Rationale 1: There is a decrease in the amount of saliva available to lubricate the food with aging.
Reference: Page 562

Rationale 2: There is an increased incidence of hiatal hernia that occurs with aging. Hiatal hernia occurs when a small portion of the stomach slides into the chest cavity trapping some of the stomach and its contents.
Reference: Page 562

Rationale 3: The lower esophageal sphincter muscle weakens with aging, increasing the likelihood of reflux.
Reference: Page 562

Rationale 4: Aging usually affects the esophagus with a decrease in peristalsis.
Reference: Page 562

Global Rationale:

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 2. Recognize the impact of age-related changes on gastrointestinal function.

Question 8

Type: MCSA

How should the nurse instruct an older patient with gastroesophageal reflux disease (GERD) about heartburn?

1. It improves when lying flat or bending over.

2. It is unaffected by the size of meals eaten or the types of food.

3. It will not put the older patient at increased risk for esophageal cancer.

4. It may cause severe chest pain that causes the patient to fear a heart attack.

Correct Answer: 4

Rationale 1: Heartburn will become worse when lying flat or bending over.
Reference: Page 563

Rationale 2: The heartburn is worsened by eating large meals and eating specific foods or beverages, which are often those high in fat or caffeine.
Reference: Page 563

Rationale 3: Approximately 10 to 15% of older patients with GERD develop Barretts esophagus, which is a precancerous inflammation of the cells lining the esophagus resulting from chronic exposure to the acid reflux.
Reference: Page 563

Rationale 4: The heartburn associated with gastroesophageal reflux disease (GERD) can cause chest pain that is so severe and persistent that the older patient is unable to distinguish the pain from cardiac pain and may seek emergency medical attention.
Reference: Page 563

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 5. Define appropriate nursing interventions directed toward assisting the older adult with gastrointestinal problems to develop self-care abilities.

Question 9

Type: MCSA

An older patient with gastroesophageal reflux disease (GERD) is prescribed ranitidine (Zantac). What should the nurse instruct as the mechanism of action of this medication?

1. Neutralizes stomach acid

2. Decreases acid production in the stomach

3. Creates a coating that acts as a protective barrier

4. Increases motility in the esophagus and stomach

Correct Answer: 2

Rationale 1: Antacids are medications that neutralize the stomach acid already produced.
Reference: Page 564

Rationale 2: Histamine blocker medications, such as ranitidine (Zantac), act by reducing acid production by blocking the histamine-2 receptor in the stomach.
Reference: Page 564

Rationale 3: Sucralfate (Carafate) is given to create a protective barrier on the mucous lining of the esophagus and stomach.
Reference: Page 564

Rationale 4: Medications that increase peristalsis include metoclopramide (Reglan).
Reference: Page 564

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 5. Define appropriate nursing interventions directed toward assisting the older adult with gastrointestinal problems to develop self-care abilities.

Question 10

Type: MCMA

Which manifestations that an older patient is exhibiting should the nurse investigate as possibly being caused by peptic ulcer disease?

Standard Text: Select all that apply.

1. Diarrhea

2. Clay-colored stools

3. Abdominal distention

4. Indigestion with bloating

5. Vague and diffuse abdominal pain

Correct Answer: 3,4,5

Rationale 1: Diarrhea is not a manifestation of peptic ulcer disease.
Reference: Page 568

Rationale 2: Clay-colored stools are not a manifestation of peptic ulcer disease.
Reference: Page 568

Rationale 3: Abdominal distention is a common symptom but is often not vigorously investigated.
Reference: Page 568

Rationale 4: Indigestion with bloating is a common symptom but is often not vigorously investigated.
Reference: Page 568

Rationale 5: When abdominal pain is present it is often vague and diffuse throughout the abdomen.
Reference: Page 568

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4. Interpret unique presentations of gastrointestinal problems in the older person.

Question 11

Type: MCMA

An older patient is diagnosed with a large peptic ulcer. Which information will the nurse use from the patients history to help identify the cause for this ulcer?

Standard Text: Select all that apply.

1. Allergy to penicillin

2. History of cataract surgery several months ago

3. Taking prescribed medication for hypertension

4. Taking ibuprofen (Motrin) for chronic bursitis pain

5. Prescribed warfarin (Coumadin) for chronic atrial fibrillation

Correct Answer: 4,5

Rationale 1: An allergy to penicillin would not contribute to the development of a peptic ulcer.
Reference: Page 567

Rationale 2: Cataract surgery would not contribute to the development of a peptic ulcer.
Reference: Page 567

Rationale 3: Taking prescribed medication for hypertension would not contribute to the development of a peptic ulcer.
Reference: Page 567

Rationale 4: NSAID use increases the incidence of peptic ulcer disease.
Reference: Page 567

Rationale 5: Concurrent use of NSAIDs with an anticoagulant such as warfarin (Coumadin) predisposes older adults to peptic ulcer development.
Reference: Page 567

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4. Interpret unique presentations of gastrointestinal problems in the older person.

Question 12

Type: MCMA

The nurse is concerned that an older patient is at risk for developing diverticulosis. What did the nurse assess in the patient?

Standard Text: Select all that apply.

1. History of constipation

2. Low intake of dietary fiber

3. Intake high in protein and calcium

4. Diet high in refined carbohydrates

5. Physically inactive for many years

Correct Answer: 1,2,4,5

Rationale 1: Constipation is an aggravating factor for diverticulosis.
Reference: Page 570

Rationale 2: Low intake of dietary fiber can encourage the development of diverticulosis.
Reference: Page 570

Rationale 3: An intake that is high in protein and calcium are not aggravating factors for diverticulosis.
Reference: Page 570

Rationale 4: A diet high in refined carbohydrates can encourage the development of diverticulosis.
Reference: Page 570

Rationale 5: Physical inactivity is an aggravating factor for diverticulosis.
Reference: Page 570

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4. Interpret unique presentations of gastrointestinal problems in the older person.

Question 13

Type: MCSA

An older patient with diverticular disease is experiencing abdominal pain and fever. For which diagnostic test will the nurse most likely prepare this patient?

1. Colonoscopy

2. Barium enema

3. Upper GI endoscopy

4. CT scan of the abdomen

Correct Answer: 4

Rationale 1: Invasive studies such as colonoscopy should be delayed until the inflammation and infection resolve with treatment because of the increased risk of bowel perforation.
Reference: Page 571

Rationale 2: Invasive studies such as barium enema should be delayed until the inflammation and infection resolve with treatment because of the increased risk of bowel perforation.
Reference: Page 571

Rationale 3: The upper GI endoscopy is not indicated.
Reference: Page 571

Rationale 4: An abdominal computerized tomography (CT) scan will most likely be obtained to assess colonic wall thickness and extra luminal structures for suspected diverticulitis.
Reference: Page 571

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4. Interpret unique presentations of gastrointestinal problems in the older person.

Question 14

Type: MCMA

An older patient is experiencing abdominal discomfort. What should the nurse do when examining this patients abdominal area?

Standard Text: Select all that apply.

1. Warm the hands.

2. Begin with very light palpation.

3. Use moderate pressure on the painful area.

4. Palpate in areas farther away from the pain.

5. Begin the assessment with the area of most pain.

Correct Answer: 1,2,4

Rationale 1: When palpating the abdomen of an older person with abdominal discomfort or pain, always begin with warm hands.
Reference: Page 571

Rationale 2: When palpating the abdomen of an older person with abdominal discomfort or pain, always begin with very light palpation.
Reference: Page 571

Rationale 3: Moderate pressure on painful areas should not be done since this could cause unnecessary discomfort for the older patient.
Reference: Page 571

Rationale 4: When palpating the abdomen of an older person with abdominal discomfort or pain, always begin in an area as remote from the area of pain as possible.
Reference: Page 571

Rationale 5: The painful abdominal area should be assessed last.
Reference: Page 571

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4. Interpret unique presentations of gastrointestinal problems in the older person.

Question 15

Type: MCSA

What should the nurse teach an older patient about colorectal cancer?

1. The risk of colorectal cancer decreases with age.

2. Colorectal cancer can be detected by measuring carcinoembryonic antigen (CEA).

3. Colorectal cancer occurs less frequently in those with a history of ulcerative colitis.

4. Colorectal cancer has no symptoms but can be detected by fecal occult blood testing.

Correct Answer: 4

Rationale 1: The risk of colorectal cancer rises with age and is the most common cancer after the age of 65.
Reference: Page 573

Rationale 2: Carcinoembryonic antigen (CEA) is not considered a diagnostic test but is used as a tumor marker to follow and manage the disease in patients diagnosed with the disease.
Reference: Page 573

Rationale 3: The incidence of colorectal cancer is increased in patients with a history of ulcerative colitis.
Reference: Page 573

Rationale 4: Colorectal cancer is asymptomatic in the early stages. Screening tools, such as annual fecal occult blood testing can detect the cancer when it is still in the curable stage.
Reference: Page 573

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4. Interpret unique presentations of gastrointestinal problems in the older person.

Question 16

Type: MCMA

The nurse is assisting an older patient with dysphagia to eat an evening meal. Which foods on the patients tray should be avoided?

Standard Text: Select all that apply.

1. Hot tea

2. Custard

3. Pudding

4. Milkshake

5. Clear broth

Correct Answer: 1,5

Rationale 1: Thin food and liquids such as tea are difficult for older people with dysphagia to swallow. Thin liquids quickly drain into the esophagus before the swallow reflex is triggered.
Reference: Page 560

Rationale 2: Thickened liquids slow the swallow process, give the older person time to prepare for the swallow, and help prevent aspiration and dehydration.
Reference: Page 560

Rationale 3: Thickened liquids slow the swallow process, give the older person time to prepare for the swallow, and help prevent aspiration and dehydration.
Reference: Page 560

Rationale 4: Thickened liquids slow the swallow process, give the older person time to prepare for the swallow, and help prevent aspiration and dehydration.
Reference: Page 560

Rationale 5: Thin food and liquids such as clear broth are difficult for older people with dysphagia to swallow. Thin liquids quickly drain into the esophagus before the swallow reflex is triggered.
Reference: Page 560

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Basic Care and Comfort

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 6. Formulate and implement appropriate nursing interventions to care for the older person with gastrointestinal problems.

Question 17

Type: MCMA

The nurse is concerned that an older patient is experiencing dysphagia. What did the nurse assess in this patient?

Standard Text: Select all that apply.

1. Slurred speech

2. Extreme lethargy

3. Talking while eating

4. Weak voice and cough

5. Drooling saliva from the mouth

Correct Answer: 1,2,4,5

Rationale 1: Slurred speech is a manifestation of dysphagia.
Reference: Page 560

Rationale 2: Extreme lethargy is a manifestation of dysphagia.
Reference: Page 560

Rationale 3: Talking while eating is not a manifestation of dysphagia.
Reference: Page 560

Rationale 4: A weak voice and cough is a manifestation of dysphagia.
Reference: Page 560

Rationale 5: Drooling saliva from the mouth is a manifestation of dysphagia.
Reference: Page 560

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Basic Care and Comfort

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4. Interpret unique presentations of gastrointestinal problems in the older person.

Question 18

Type: MCSA

An older patient with a history of constipation has been directed to use an over-the-counter medication to help manage symptoms of gastroesophageal reflux by buffering the gastric pH. Which medication would be the best for the patient to use?

1. Pepcid

2. Maalox

3. Mylanta

4. Milk of Magnesia

Correct Answer: 4

Rationale 1: A histamine2 receptor agonist like Pepcid decreases acid production by inhibiting histamine stimulation of the parietal cells.
Reference: Page 564

Rationale 2: Maalox can cause constipation.
Reference: Page 564

Rationale 3: Mylanta can cause constipation.
Reference: Page 564

Rationale 4: Milk of Magnesia is an over-the-counter option to manage gastroesophageal reflux and acts to provide a buffer for the gastric pH.
Reference: Page 564

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 5. Define appropriate nursing interventions directed toward assisting the older adult with gastrointestinal problems to develop self-care abilities.

Question 19

Type: MCSA

An older patient with gastroesophageal reflux disease has complications caused by exposure of tissue to gastric acids. Which medication will this patient most likely be prescribed to promote healing?

1. Reglan

2. Zantac

3. Pepcid

4. Carafate

Correct Answer: 4

Rationale 1: Reglan is a promotility agent that enhances esophageal clearance and gastric emptying.
Reference: Page 565

Rationale 2: Zantac is a histamine2 receptor agonist that acts by reducing acid production.
Reference: Page 565

Rationale 3: Pepcid is a histamine2 receptor agonist that acts by reducing acid production.
Reference: Page 565

Rationale 4: Sucralfate (Carafate) is a mucosal protectant agent that aids in mucosal healing by reducing direct tissue exposure to acid. Sucralfate works locally by forming an adherent complex that coats the ulcer site and protects it from further injury from acid, pepsin, and bile salts.
Reference: Page 565

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 5. Define appropriate nursing interventions directed toward assisting the older adult with gastrointestinal problems to develop self-care abilities.

Question 20

Type: MCSA

The nurse is planning a teaching session regarding gastrointestinal ulcers for the residents of an assisted living complex. Which concept should the nurse include in the presentation?

1. Gastric ulcers are more common than duodenal ulcers.

2. The first sign of a peptic ulcer may be serious gastrointestinal bleeding.

3. A colonoscopy is the test used to diagnose the presence of a gastric ulcer.

4. The individual having a peptic ulcer will most likely experience pain when hungry.

Correct Answer: 2

Rationale 1: Duodenal ulcers are more common than gastric ulcers.
Reference: Page 567

Rationale 2: The first signs of peptic ulcer disease may be serious gastrointestinal bleeding episodes requiring emergency evaluation, treatment, and transfusion.
Reference: Page 567

Rationale 3: Tests used to diagnose a gastric ulcer include an endoscopy and H. pylori testing.
Reference: Page 567

Rationale 4: The individual who has a peptic ulcer will most likely have abdominal pain after eating.
Reference: Page 567

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 4. Interpret unique presentations of gastrointestinal problems in the older person.

Question 21

Type: MCSA

An older patient, beginning antibiotic therapy for a leg wound, has a history of Clostridium difficile. What should the nurse instruct the patient to do to reduce the risk of this occurring?

1. Eat large amounts of fresh fruits and vegetables.

2. Restrict the amount of meat and calcium products.

3. Use acidophilus capsules while taking the antibiotic.

4. Decrease the amount of fluid taken while on the medication.

Correct Answer: 3

Rationale 1: Eating large amounts of fresh fruits and vegetables will not reduce the patients risk for developing Clostridium difficile.

Rationale 2: Restricting the amount of meat and calcium products will not reduce the patients risk for developing Clostridium difficile.

Rationale 3: Acidophilus capsules contain active cultures that can be used to treat a variety of gastrointestinal problems and as an adjunct to antibiotic therapy to prevent antibiotic-associated diarrhea caused by overgrowth of Clostridium difficile.

Rationale 4: Decreasing the amount of fluid taken while on the medication will not reduce the patients risk for developing Clostridium difficile.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 5. Define appropriate nursing interventions directed toward assisting the older adult with gastrointestinal problems to develop self-care abilities.

Question 22

Type: MCSA

An older patient with a peptic ulcer asks why lifestyle alterations are needed. What should the nurse explain to the patient?

1. Alcohol stimulates gastric acid secretion.

2. Alcohol acts to suppress gastric immunity.

3. Caffeine is associated with abdominal pain.

4. Tobacco reduces the effectiveness of gastric ulcer medications.

Correct Answer: 1

Rationale 1: Alcohol stimulates gastric acid secretion which can contribute to the development of peptic ulcers.
Reference: Page 563

Rationale 2: Alcohol does not suppress gastric immunity.
Reference: Page 563

Rationale 3: Caffeine delays healing.
Reference: Page 563

Rationale 4: Tobacco delays healing but does not reduce the effectiveness of gastric ulcer medication.
Reference: Page 563

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 5. Define appropriate nursing interventions directed toward assisting the older adult with gastrointestinal problems to develop self-care abilities.

Question 23

Type: MCSA

The nurse is preparing discharge instructions for an older patient with chronic pancreatitis. Which information should the nurse include in this teaching?

1. Stop smoking.

2. Limit fluid intake.

3. Do not drink any alcohol.

4. Avoid eating organ meats.

Correct Answer: 3

Rationale 1: Smoking has not been identified as causing chronic pancreatitis.
Reference: Page 580

Rationale 2: A fluid restriction is not required in chronic pancreatitis.
Reference: Page 580

Rationale 3: All older adults with chronic pancreatitis must refrain from drinking alcohol.
Reference: Page 580

Rationale 4: Organ meats have not been identified as causing or contributing to chronic pancreatitis.
Reference: Page 580

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 5. Define appropriate nursing interventions directed toward assisting the older adult with gastrointestinal problems to develop self-care abilities.

Question 24

Type: MCSA

The nurse is teaching an older patient with diverticulitis on foods that could precipitate a painful attack. How should the nurse instruct this patient?

1. Avoid foods with seeds.

2. Restrict the intake of high fiber foods.

3. Limit the intake of eggs and dairy products.

4. Eat whole grains with sesame seeds for added protein.

Correct Answer: 1

Rationale 1: The patient should be instructed to avoid foods that precipitate painful attacks such as foods with seeds like popcorn, sesame seeds, and poppy seeds. These seeds can become trapped in the diverticula and trigger an infection and inflammatory response.
Reference: Page 571

Rationale 2: High fiber foods should be encouraged.
Reference: Page 571

Rationale 3: There is no reason for the patient to limit the intake of eggs and dairy products.
Reference: Page 571

Rationale 4: Whole grains with sesame seeds can precipitate painful attacks. The seeds can become trapped in the diverticula.
Reference: Page 571

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 5. Define appropriate nursing interventions directed toward assisting the older adult with gastrointestinal problems to develop self-care abilities.

Question 25

Type: MCSA

An older patient with intermittent diarrhea has been advised to increase the amount of soluble fiber in the diet. What should the nurse suggest to this patient?

1. Use Metamucil as prescribed.

2. Restrict the intake of oranges.

3. Limit eating frozen vegetables.

4. Do not eat the peels of apples or pears.

Correct Answer: 1

Rationale 1: Soluble fiber (Metamucil) adds bulk to the stool and is sometimes helpful to slow bowel movements in people requiring bulk.
Reference: Page 577

Rationale 2: There is no reason for the patient to restrict the intake of oranges.
Reference: Page 577

Rationale 3: Frozen vegetables could be another source of soluble fiber.
Reference: Page 577

Rationale 4: The peels of apples or pears could be another source of soluble fiber.
Reference: Page 577

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 5. Define appropriate nursing interventions directed toward assisting the older adult with gastrointestinal problems to develop self-care abilities.

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