Chapter 44: Care of the Patient with a Gastrointestinal Disorder My Nursing Test Banks

Chapter 44: Care of the Patient with a Gastrointestinal Disorder

Cooper and Gosnell: Foundations and Adult Health Nursing, 7th Edition

MULTIPLE CHOICE

1.The nurse clarifies that the end product of carbohydrate metabolism is absorbed and put into the blood stream by the:

a. gastric lining of the stomach.
b. villi of the small intestine.
c. bile of the liver in the large intestine.
d. excretion from the cecum.

ANS: B

The inner surface of the small intestine contains millions of tiny, fingerlike projections called villi, which contain small blood vessels. They are responsible for absorbing the products of digestion.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 5-6

OBJ: 2 TOP: Digestive KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity

2.A 56 -year-old man is admitted to the emergency room with an acute attack of diverticulitis. The patient has a temperature of 102 F, and has an elevated white count. Which assessment would alert the nurse to impending septic shock?

a. Chest pain
b. Seizure
c. Tachycardia
d. Massive diarrhea

ANS: C

The patient with diverticulitis who has fever and an elevated white count has an infection that could lead to septic shock, which will present as tachycardia and hypotension.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 5-98

OBJ:9TOPiverticulitis

KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

3.Because bowel contents from an ileostomy are virtually liquid, what should the nurse include in the plan of care?

a. Evaluation and assessment of dietary intake of fiber
b. Evaluation and assessment of patient cleanliness
c. Evaluation and assessment of periostomal skin integrity
d. Evaluation and assessment of the adequacy of the collection device

ANS: C

The nurse should assess the periostomal skin for impairment of integrity. The fecal material is liquid and has a potential for severe skin excoriation from the digestive enzymes.

PTS: 1 DIF: Cognitive Level: Application REF: Page 5-5-84

OBJ:8TOP:Ulcerative colitis

KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

4.The home health nurse caring for a patient who has dysarthria related to radiation therapy for an oral cancer would recommend that the family provide:

a. a tablet and pencil as a communication aid.
b. a TV for diversion.
c. a bell to summon help.
d. a walkie-talkie.

ANS: A

The provision of an alternative method of communicating will lessen the frustration of the patient who has trouble speaking understandably. The call bell would be helpful also, but without a way to communicate, the bell is not as essential as a method of communication.

PTS: 1 DIF: Cognitive Level: Application REF: Page 5-28

OBJ:5TOP:Cancer of esophagus

KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

5.Which recommendation is most appropriate for a patient who has had an esophageal dilation related to achalasia?

a. Consume only liquid
b. Avoid fruit juices
c. Drink 10 oz of fluid with each meal
d. Lie down for 30 minutes after each meal

ANS: C

The patient should drink fluid with each meal to increase lower esophageal pressure to push food into the stomach.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 5-41

OBJ:5TOP:Esophageal dilation

KEY:Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

6.A patient who is being evaluated for episodes of hematemesis and dyspepsia tells the nurse that pain occurs when he eats, but pain does not waken him. The nurse recognizes a diagnostic sign of which condition?

a. Duodenal ulcer
b. Gastritis
c. Achalasia
d. Peptic ulcer

ANS: D

A significant subjective data assessment for a peptic ulcer is the patient report that pain is associated with eating, but not with an empty stomach, because there would be pain with a duodenal ulcer.

PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 5-46

OBJ: 5 TOP: Peptic ulcer KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity

7.The nurse anticipates that the patient who has had a subtotal gastrectomy will need supplemental:

a. protein due to the loss of some of the digestive processes.
b. vitamin B12 due to the loss of the intrinsic factor.
c. bulk to prevent constipation.
d. vitamin A due to the loss of the gastric lining.

ANS: B

It is recommended that all patients with a gastrectomy have a blood serum vitamin B12 level measured every 1 to 2 years. Decreased absorption of vitamin B12 may cause pernicious anemia.

PTS: 1 DIF: Cognitive Level: Application REF: Page 5-61

OBJ: 6 TOP: Gastrectomy KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity

8.The home health nurse is caring for a patient who has frequent bouts of diverticulitis accompanied by increased flatulence, diarrhea, and nausea. Which of the following is the most appropriate suggestion to lessen these symptoms?

a. Eat a diet high in fiber content
b. Increase dietary fat intake
c. Exercise to increase intra-abdominal pressure
d. Take daily laxatives

ANS: A

The  symptoms of diverticulitis can be reduced or prevented by eating a high-fiber diet, reduction of meat and fats in the diet, and avoiding activities that increase intra-abdominal pressure. Although laxatives might be prescribed sparingly, daily laxatives are not recommended.

PTS: 1 DIF: Cognitive Level: Analysis REF: Page 5-99

OBJ:9TOPiverticulitis

KEY:Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

9.The nurse caring for a patient with a peptic ulcer who has had a nasogastric tube inserted notes bright blood in the tube; the patient complains of pain and has become hypotensive. Which condition should the nurse recognize these as signs of?

a. Hiatal hernia
b. Gastritis
c. Perforation
d. Bowel obstruction

ANS: C

Perforation of the gastric wall causes pain, hypotension, and hematemesis. Immediate reporting to the charge nurse/physician is essential as peritonitis, potentially lethal, is the result of a perforation.

PTS: 1 DIF: Cognitive Level: Analysis REF: Page 5-47

OBJ:5TOP:Ulcer perforation

KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

10.Dumping syndrome after a Billroth II procedure occurs when high-carbohydrate foods are ingested over a period of less than 20 minutes. What would the nurse suggest to reduce the risk of dumping syndrome?

a. Eating a high-carbohydrate diet
b. Drinking 10 oz of fluids with meals
c. Remaining upright for 2 hours after meals
d. Eating six small daily meals high in protein and fat

ANS: D

Treatment for dumping syndrome includes eating six small meals daily that are high in protein and fat, and low in carbohydrates. Fluids should be avoided during meals. If possible, the patient should lie down for 1 hour after meals.

PTS: 1 DIF: Cognitive Level: Analysis REF: Page 5-60

OBJ:4TOPumping syndrome

KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity

11.The patient has come to the PACU following an ileostomy for the treatment of ulcerative colitis. The patient is conscious and has a nasogastric tube in place and a pouch over the stoma. What should be the nurses initial action?

a. Turn patient to right side
b. Give patient ice chips to moisten mouth
c. Attach NG tube to suction
d. Irrigate NG tube

ANS: C

Initially, the NG tube should be attached to suction to decompress the stomach and prevent nausea. Assessing the tube for the need of future irrigation will be part of the postoperative care.

PTS: 1 DIF: Cognitive Level: Application REF: Page 5-85, Box 5-5

OBJ: 4 TOP: Appendicitis KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity

12.The home health nurse evaluates a patient being treated for a peptic ulcer with Riopan (antacid) and famotidine (histamine receptor blocker). Which statement made by the patient indicates a need for further instruction?

a. I know famotidine will not interfere with my Coumadin.
b. I take the Riopan at least 2 hours after any of my other drugs.
c. Boy! That Riopan keeps my stomach happy!
d. I take both those meds at the same time every morning.

ANS: D

Antacids should not be taken with other drugs, because the absorption of the other drugs may be affected.

PTS: 1 DIF: Cognitive Level: Analysis REF: Page 5-49, Table 5-1

OBJ:4TOPharmacology

KEY: Nursing Process Step: Evaluation MSC: NCLEX: Physiological Integrity

13.What should a nurse do when obtaining a stool specimen to be examined for ova and parasites?

a. Use an oil retention enema to facilitate collection
b. Refrigerate the specimen immediately
c. Obtain three different stool specimens on subsequent days
d. Check the specimen for the presence of occult blood

ANS: C

Diagnosing a parasitic infection requires three different stool specimens on subsequent days. Use only normal saline or tap water enemas to prevent alteration of results.

PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 5-18

OBJ:3TOPiagnostic studies

KEY:Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

14.The nurse explains to the patient with Crohn disease that the tube feedings allow for:

a. Rapid absorption in the upper GI tract
b. Decompression of the stomach
c. Reduction of diarrheic episodes
d. A permanent nutritional support

ANS: A

The tube feedings allow for rapid absorption of the nutrients in the upper GI tract. The tube feedings are not permanent and will be followed by oral intake of a low-residue, high-protein,  high-calorie diet.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 5-91

OBJ:7TOP:Crohn disease

KEY:Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

15.A patient with a large inguinal hernia has abdominal distention and inguinal pain. The nurse recognizes these as indicators of which type of hernia?

a. Strangulated
b. Hiatal
c. Ventral
d. Umbilical

ANS: A

The hernia is strangulated when the blood supply and intestinal flow are occluded, which results in pain and distention.

PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 5-105

OBJ:10TOP:Inguinal hernia

KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

16.A patient with a ruptured diverticulum in the descending colon has undergone a transverse loop colostomy. The patient is upset and says, I didnt know it was going to be this awful. I hate this! Which response made by the nurse would be most helpful?

a. This is a temporary solution. It will be closed in 6 weeks.
b. This seems awful now, but you wont have the problems you had before.
c. If everything goes well the surgeon can close this colostomy in about a year.
d. With the appropriate pouch and loose clothing, no one will notice a thing.

ANS: A

The loop colostomy is a temporary colostomy that allows for complete bowel rest. It can be closed in as short a time as 6 weeks.

PTS: 1 DIF: Cognitive Level: Analysis REF: Page 5-100

OBJ:8TOPiverticulum

KEY:Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity

17.A male patient complains that he will never adjust to his colostomy. Which is the best action for the nurse in this situation?

a. Encourage him to express his concern
b. Suggest that he discuss his concerns with his physician
c. Counsel him that everything will be all right
d. Assure him that his concerns will diminish when he is able to care for his colostomy

ANS: A

When a colostomy is performed, the patient or significant other should be able to verbalize and demonstrate understanding of ostomy care to the nurse.

PTS: 1 DIF: Cognitive Level: Analysis REF: Page 5-137

OBJ: 8 TOP: Colostomy KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity

18.In caring for a patient with gastric bleeding who has a nasogastric tube in place, the nurse should include in the plan of care to ensure that the NG tube is:

a. Clamped for 10 minutes every hour
b. Kept patent with irrigation
c. Frequently repositioned to the opposite nostril
d. Changed every 72 hours

ANS: B

Irrigating the NG tube PRN will keep the tube patent and ensure effective decompression.

PTS:1DIF:Cognitive Level: Application

REF: Page 5-52, Nursing care plan 5-1 OBJ: 4 TOP: NG tube

KEY:Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

19.What should the nurse include in a teaching plan for a patient with a hiatal hernia to reduce the frequency of heartburn?

a. Drinking 10 oz of milk with every meal
b. Lie down after eating
c. Panting through mouth when symptoms begin
d. Eating small meals

ANS: D

Taking care not to overeat is the best defense again pyrosis (heartburn) for the person with a hiatal hernia.

PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 5-109

OBJ:10TOP:Hiatal hernia

KEY:Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

20.The nurse points out which of the following as an example of a nonmechanical bowel obstruction?

a. A paralytic ileus
b. Narrowed bowel lumen from an inflammatory process
c. Tumor of the bowel
d. Fecal impaction

ANS: A

A nonmechanical bowel obstruction can be caused by a paralytic ileus.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 5-111

OBJ: 4 TOP: Cancer KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity

21.Bowel sound assessment on a patient with an obstruction who has distention, nausea, and visible peristaltic waves would be:

a. loud and clearly audible.
b. high pitched.
c. hyperactive.
d. absent.

ANS: B

Because there are visible peristaltic waves, there will be bowel sounds that will be faint and high pitched.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 5-113

OBJ:11TOP:Bowel obstruction

KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

22.The patient with a peptic ulcer has been placed on regular doses of bismuth salicylate (Pepto-Bismol) to combat H. pylori. What color will this drug turn the stool?

a. Gray-black
b. Dark green
c. Red-orange
d. Yellow

ANS: A

Bismuth products turn the stool gray-black.

PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 5-49, Table 5-1

OBJ: 4 TOP: Shock KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity

23.Which of the following should be included in the patient teaching of a patient with a peptic ulcer?

a. Introducing irritating foods in minute amounts to desensitize the stomach
b. Restricting fluid to 1000 mL per day
c. Eating 6 small meals a day
d. Drinking alcohol and caffeine in moderation

ANS: C

The patient with a peptic ulcer should eat frequently to keep food in the stomach. Eating 6 small meals daily is helpful. Restriction of fluid is not necessary and irritating foods, alcohol, and caffeine should be discouraged.

PTS: 1 DIF: Cognitive Level: Analysis REF: Page 5-56

OBJ: 4 TOP: Peptic ulcer KEY: Nursing Process Step: Planning

MSC: NCLEX: Health Promotion and Maintenance

24.Which of the following would be the most helpful nursing intervention to increase the comfort of a patient with appendicitis?

a. Application of ice bag
b. Administration of small tap water enema
c. Warm compress over entire abdomen
d. Ambulate for short periods in the room

ANS: A

Application of an ice bag will decrease the flow of blood to the area and impede the inflammatory process.

PTS: 1 DIF: Cognitive Level: Application REF: Page 5-95

OBJ: 9 TOP: Appendicitis KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

25.To assist a family with a bowel training program to reduce fecal incontinence, the nurse would suggest the use of a ___________ at an optimal time to stimulate defecation.

a. Warm bath
b. A tap water enema
c. Glycerin suppository
d. Large glass of warm lemonade

ANS: C

The use of a glycerin suppository for fecal stimulation is a helpful aid in a bowel-training program. The suppository is administered at what the family and patient have determined is the optimal time for a bowel movement.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 5-124

OBJ:13TOP:Bowel training

KEY:Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

26.What is the most lethal complication of a peptic ulcer?

a. Bleeding
b. Perforation
c. Severe pain
d. Gastric outlet obstruction

ANS: B

Perforation is considered the most lethal complication of peptic ulcer. Bleeding may occur when the ulcer erodes into a blood vessel; however, perforation occurs when the ulcer crater penetrates the entire thickness of the wall of the stomach or duodenum. Gastric outlet obstruction can occur at any time and can be relieved by NG aspiration of stomach contents.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 5-47

OBJ:4TOPisorders of the stomach

KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity

27.The nurse takes into consideration that a proton pump inhibitor drug, such as ______________, will completely eradicate gastric acid production.

a. omeprazole (Prilosec)
b. ranitidine (Zantac)
c. sucralfate (Carafate)
d. olsalazine (Dipentum)

ANS: A

Omeprazole (Prilosec) is a proton pump inhibitor that interferes with the production of gastric acid.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 5- 32

OBJ:4TOPisorders of the stomach

KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity

28.Which of the following is the purpose of antibiotic therapy in treating peptic ulcers?

a. It eradicates H. pylori
b. It inhibits gastric acid secretion
c. It protects the gastric mucosa
d. It neutralizes or reduces the acidity of stomach contents

ANS: A

Antibiotic therapy eradicates H. pylori.

PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 5-49, 5-50

OBJ: 4 TOP: Peptic ulcers KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity

29.Why are peptic ulcers a common problem of aging?

a. Because of overuse of antibiotics
b. Because of overuse of antacids
c. Because of overuse of NSAIDs
d. Because of overuse of laxatives

ANS: C

Medications such as aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) taken for arthritis or degenerative joint conditions may contribute to ulcer formation.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 5-110

OBJ:4TOPisorders of the stomach

KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

30.The patient with irritable bowel syndrome tells the home health nurse she is going to an acupuncturist for therapy for her condition. Which of the following would be the best

nursing response?

a. Go for it. Alternative medicine does great things.
b. YIKES! An acupuncturist?
c. It may help, but there has been no clinical proof of its effectiveness.
d. You should confirm that the acupuncturist is licensed.

ANS: C

While it is true that some have found relief there is no evidence that these therapies relieve the symptoms of IBS.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 5-76

OBJ:4TOP:Alternative therapy

KEY:Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

MULTIPLE RESPONSE

31.Which of the following are indicators of colorectal cancer? (Select all that apply.)

a. Constant diarrhea
b. Excessive flatulence
c. Cachexia
d. Cramps
e. Rectal bleeding
f. Anemia

ANS: B, C, D, E, F

The indicators for colorectal cancer are changing bowel habits between diarrhea and constipation, flatulence, cachexia, cramps, rectal bleeding, and anemia.

PTS: 1 DIF: Cognitive Level: Analysis REF: Page 5-118

OBJ:12TOP:Colorectal cancer

KEY:Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

32.How should the nurse counsel the 34-year-old woman who has been prescribed sulfasalazine (Azulfidine) for Crohn disease? (Select all that apply.)

a. Expose her to sunlight at least 30 minutes a day for vitamin D synthesis
b. Tell her to drink at least 1500 mL of fluid a day
c. Advise assessing self for rash
d. Use alternate birth control methods to oral contraception
e. Take drug on an empty stomach

ANS: B, C, D

Cautionary information about sulfasalazine (Azulfidine) would include having adequate fluid intake to prevent crystallization in the kidneys, avoiding exposure to the sun, and using alternate birth control methods as oral contraception is made unreliable by this drug. The drug should be taken with meals and the patient should be assessing for rash.

PTS: 1 DIF: Cognitive Level: Analysis REF: Page 5-49, Table 5-1, 5-82

OBJ:7TOP:Crohn disease

KEY: Nursing Process Step: Planning MSC: NCLEX: Safe, Effective Care Environment

33.In designing a teaching plan to present to a group of older adults regarding the prevention of esophageal cancer, the nurse would include information about the significance of (select all that apply):

a. cessation of smoking.
b. good oral care.
c. regular checkups if dysphagia is present.
d. reducing excessive weight.
e. limiting alcohol consumption.
f. reduction of consumption of citrus fruits.

ANS: A, B, C, E

Preventative measures include cessation of smoking and alcohol consumption, good oral care, and medical evaluation of dysphagia. Weight and reduction of citrus fruits are non-contributory to prevention of esophageal cancer.

PTS: 1 DIF: Cognitive Level: Application REF: Pages 5-24, 5-25

OBJ:6TOP:Esophageal cancer

KEY:Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

34.Which activities should the home health nurse suggest to an elderly patient to avoid constipation? (Select all that apply.)

a. Increasing physical activity
b. Taking bulk-forming  laxatives
c. Increasing fiber intake
d. Drinking at least 1000 mL fluid
e. Taking a daily stool softener
f. Using tap water enemas for persons with altered mobility

ANS: A, B, C, D

Inactivity and changes in diet and fluid intake can contribute to constipation. A nutritional diet high in fiber and bulk-forming foods can promote normal elimination. Increasing fluids to 8 to 10 glasses per day will be beneficial in preventing constipation. A daily bowel routine will also benefit elimination. Use of daily stool softeners is no longer recommended for the older adult. Tap water enemas for persons with altered mobility are is helpful.

PTS: 1 DIF: Cognitive Level: Analysis REF: Page 5- 129

OBJ:4TOPisorders of intestine

KEY:Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

35.The home health nurse is caring for a patient who has frequent abdominal pain and diarrhea. The nurse uses the Rome Criteria to direct assessment for irritable bowel syndrome. What is included in the Rome Criteria? (Select all that apply.)

a. Discomfort at least 3 days a month
b. Blood in stool
c. Pain relieved by defecation
d. Excessive flatulence
e. Nausea and vomiting associated with onset
f. Onset associated with change in stool consistency or frequency

ANS: A, C, F

The Rome Criteria include that the patient experience discomfort at least 3 days a month within the last 3 months, pain relieved by defecation, onset associated with change in stool frequency, and onset in association with a change in stool appearance. Although increased flatus is associated with diverticulitis, it is not part of the Rome Criteria.

PTS: 1 DIF: Cognitive Level: Application REF: Page 5-74

OBJ:5TOP:Rome Criteria

KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

COMPLETION

36.Flexible sigmoidoscopy should be performed every ________ years.

ANS:

5

Flexible sigmoidoscopy should be performed every 5 years. Endoscopy of the lower GI tract allows visualization and, if indicated, access to obtain biopsy specimens of tumors, polyps, or ulcerations of the anus, rectum, and sigmoid colon. The lower GI tract is difficult to visualize radiographically, but sigmoidoscopy allows direct visualization.

Topic: Screening for colorectal cancer

Nursing Process Step: Planning

Objective: 3

Cognitive Level: Knowledge

NCLEX: Physiological Integrity

Text Reference: Page 5-119

PTS:1DIF:Cognitive Level: Knowledge

REFage 1448, Health PromotionOBJ:3

TOP: Screening for colorectal cancer KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity

37.The nurse explains that ___________, the chief enzyme of gastric juice, is activated by hydrochloric acid to begin digestion of protein.

ANS:

pepsin

Pepsin is activated by the hydrochloric acid to break down protein for digestion.

Topic: Pepsin

Nursing Process Step: Implementation

Objective: 2

Cognitive Level: Knowledge

NCLEX: Physiological Integrity

Text Reference: Page 5-5

PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1403

OBJ: 2 TOP: Pepsin KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

38.The nurse caring for a patient with Crohn disease will closely monitor the urinary output to ensure that the patient is excreting at least _______mL/day.

ANS:

1500

The output of 1500 mL a day indicates good kidney perfusion. The disease allows such dramatic fluid loss that a constant watch on I&O is a major nursing intervention.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 5-91

OBJ:7TOP:Crohn disease

KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

39.The nurse takes into consideration that long-term use of antibiotics can cause an antibiotic-associated pseudomembranous colitis from the organism________.

ANS:

C. difficile

 C. difficile causes a type of colitis from long-term antibiotic use to which older adults are extremely susceptible.

PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 5-65

OBJ: 4 TOP: C. difficile KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity

40.Due to frequent bouts of constipation, the nurse examines the bedfast nursing home resident for ulceration of the anus, called __________________.

ANS:

anal fissure

Ulceration and laceration of the anal skin can occur because of overstretching with the passing of constipated stool.

PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 5-131

OBJ: N/A TOP: Anal fissure KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity

OTHER

41.The nurse uses a poster to show the process of bowel obstruction from diverticulitis. Arrange the pathophysiologic event in order. (Separate letters by a comma and space as follows: A, B, C, D)

a. Increase in intra-abdominal pressure

b. Weakened wall of sigmoid

c. Pouch fills with fecal matter

d. Pouch protrudes through smooth muscle

e. Narrowing of bowel lumen

f. Inflammation of diverticula

ANS:

B, A, D, C, F, E

Bowel obstruction from diverticulitis follows a sequential path: The wall of the bowel is weakened (usually the sigmoid), increase in abdominal pressure from such activities as bending and carrying heavy loads causes a pouch to protrude through the smooth muscle of the colon, the pouch fills with fecal matter, becomes inflamed, and narrows the lumen of the bowel causing obstruction.

Topic: Bowel Obstruction

Nursing Process Step: Planning

Objective: 9

Cognitive Analysis

NCLEX: Health Promotion and Maintenance

Text Reference: Pages 5-97, 5-98

PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1440

OBJ:9TOP:Bowel Obstruction

KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance

42.Celiac sprue in the adult can lead to systemic problems. Arrange the pathophysical events of this in order of their appearance. (Separate letters by a comma and space as follows: A, B, C, D)

a. Malabsorption

b. Weight loss/vitamin deficiency

c. Systemic involvement

d. Diarrhea

e. Ingestion of gluten

f. Destruction of villi in the small intestine

ANS:

E, F, A, D, B, C

The ingestion of gluten in the small intestine damages the villi, which leads to malabsorption and diarrhea. Weight loss and vitamin deficiency, which occur from altered nutrition, can expand into systemic involvement.

Topic: Celiac sprue

Nursing Process Step: Planning

Objective: 4

Cognitive Analysis

NCLEX: Physiological Integrity

Text Reference: Pages 5-70, 5-71

PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1430

OBJ: 4 TOP: Celiac sprue KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity

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