N124 Lower GI

1. 1A female college student goes to the university health clinic complaining of pain that started at the umbilicus and moved to the right lower quadrant over the last 12 hours. You notice muscle guarding on examination. What action should you take?

   1. AAdminister a PRN laxative per standing orders.
   2. BAsk about the last menstrual period.
   3. CMake the student NPO.
   4. DAssess bowel sounds.
2. 2What is a classic diagnostic finding in a patient with appendicitis?

   1. AElevated white blood cell (WBC) count
   2. BElevated level of lipase
   3. CLeft lower quadrant tenderness
   4. DPositive Kernig's sign
3. 3Which is a complication in patients with ulcerative colitis?

   1. AHyperkalemia
   2. BToxic megacolon
   3. CPancreatitis
   4. DBarrett's esophagus
4. 4The appropriate collaborative therapy for the patient with acute diarrhea caused by a viral infection is to:

   1. Aincrease fluid intake
   2. Badminister an antibiotic
   3. Cadminister antimotality drugs
   4. Dquarantine the patient to prevent spread of the virus
5. 5Assessment findings suggestive of peritonitis include

   1. Arebound abdominal pain
   2. Ba soft, distended abdomen
   3. Cdull, continuous abdominal pain
   4. Dobserving that the patient is restless
6. 6In planning care for the patient with Crohn's disease, the nurse recognizes that a major difference between ulcerative colitis and Crohn's disease is that Crohn's disease:

   1. Afrequently results in toxic megacolon
   2. Bcauses fever nutritional deficiencies than ulcerative colitis
   3. Coften recurs after surgery, whereas ulcerative colitis is curable with a colectomy
   4. Dis manifested by rectal bleeding and anemia more frequently than is ulcerative colitis
7. 7A patient with stage I colorectal cancer is scheduled for surgery. Patient teaching for this patient would include an explanation that:

   1. Achemotherapy will begin after the patient recovers from the surgery
   2. Bboth chemotherapy and radiation can be used as palliative treatments
   3. Cfollow-up colonoscopies will be needed to ensure that the cancer does not occur
   4. Da wound, ostomy, and continence nurse will visit the patient to identify an abdominal site for the ostomy
8. 8The nurse explains to the patient undergoing ostomy surgery that the procedure that maintains the most normal functioning of the bowel is:

   1. Aa sigmoid colostomy
   2. Ba transverse colostomy
   3. Ca descending colostomy
   4. Dan ascending colostomy
9. 9In contrast to diverticulitis, the patient with diverticulosis:

   1. Ahas rectal bleeding
   2. Boften has no symptoms
   3. Chas localized cramping pain
   4. Dfrequently develops peritonitis
10. 10A nursing intervention that is most appropriate to decrease post-operative edema and pain after an inguinal herniorrhaphy is:

    1. Aapplying a truss to the hernia site
    2. Ballowing the patient to stand to void
    3. Csupporting the incision during coughing
    4. Dapplying a scrotal support with ice bag

11. 11The nurse determines that the goals of dietary teaching have been met when the patient with celiac disease selects from the menu:

    1. Ascrambled eggs and sausage
    2. Bbuckwheat pancakes with syrup
    3. Coatmeal, skim milk, and orange juice
    4. Dyogurt, strawberries, and rye toast with butter
12. 12What should a patient be taught after a hemorrhoidectomy?
    

    1. ATake a mineral oil before bedtime
    2. BEat a low-fiber diet to rest the colon
    3. CAdminister oil-retention enema to empty the colon
    4. DUse prescribed pain medication before a bowel movement
13. 13The nurse is conducting discharge teaching for a patient with metastatic lung cancer who was admitted with a bowel impaction. Which instructions would be most helpful to prevent further episodes of constipation?

    1. AMaintain a high intake of fluid and fiber in the diet.
    2. BReduce intake of medications causing constipation.
    3. CEat several small meals per day to maintain bowel motility.
    4. DSit upright during meals to increase bowel motility by gravity.
14. 14The nurse should administer an as-needed dose of magnesium hydroxide (MOM) after noting what information while reviewing a patient's medical record?

    1. AAbdominal pain and bloating
    2. BNo bowel movement for 3 days
    3. CA decrease in appetite by 50% over 24 hours
    4. DMuscle tremors and other signs of hypomagnesemia
15. 15The nurse is preparing to administer a dose of bisacodyl (Dulcolax). In explaining the medication to the patient, the nurse would explain that it acts in what way?

    1. AIncreases bulk in the stool
    2. BLubricates the intestinal tract to soften feces
    3. CIncreases fluid retention in the intestinal tract
    4. DIncreases peristalsis by stimulating nerves in the colon wall
16. 16The nurse is preparing to administer a scheduled dose of docusate sodium (Colace) when the patient reports an episode of loose stool and does not want to take the medication. What is the appropriate action by the nurse?

    1. AWrite an incident report about this untoward event.
    2. BAttempt to have the family convince the patient to take the ordered dose.
    3. CWithhold the medication at this time and try to administer it later in the day.
    4. DChart the dose as not given on the medical record and explain in the nursing progress notes.
17. 17What should the nurse instruct the patient to do to best enhance the effectiveness of a daily dose of docusate sodium (Colace)?

    1. ATake a dose of mineral oil at the same time.
    2. BAdd extra salt to food on at least one meal tray.
    3. CEnsure dietary intake of 10 g of fiber each day.
    4. DTake each dose with a full glass of water or other liquid.
18. 18The nurse would question the use of which cathartic agent in a patient with renal insufficiency?

    1. ABisacodyl (Dulcolax)
    2. BLubiprostone (Amitiza)
    3. CCascara sagrada (Senekot)
    4. DMagnesium hydroxide (Milk of Magnesia)
19. 19A patient who is given a bisacodyl (Dulcolax) suppository asks the nurse how long it will take to work. The nurse replies that the patient will probably need to use the bedpan or commode within which time frame after administration?

    1. A2-5 minutes
    2. B15-60 minutes
    3. C2-4 hours
    4. D6-8 hours
20. 20The nurse is caring for a 68-year-old patient admitted with abdominal pain, nausea, and vomiting. The patient has an abdominal mass, and a bowel obstruction is suspected. The nurse auscultating the abdomen listens for which type of bowel sounds that are consistent with the patient's clinical picture?

    1. ALow-pitched and rumbling above the area of obstruction
    2. BHigh-pitched and hypoactive below the area of obstruction
    3. CLow-pitched and hyperactive below the area of obstruction
    4. DHigh-pitched and hyperactive above the area of obstruction
21. 21The nurse is planning care for a 68-year-old patient with an abdominal mass and suspected bowel obstruction. Which factor in the patient's history increases the patient's risk for colorectal cancer?

    1. AOsteoarthritis
    2. BHistory of colorectal polyps
    3. CHistory of lactose intolerance
    4. DUse of herbs as dietary supplements
22. 22The nurse is preparing to insert a nasogastric (NG) tube into a 68-year-old female patient who is nauseated and vomiting. She has an abdominal mass and suspected small intestinal obstruction. The patient asks the nurse why this procedure is necessary. What response by the nurse is most appropriate?

    1. A"The tube will help to drain the stomach contents and prevent further vomiting."
    2. B"The tube will push past the area that is blocked and thus help to stop the vomiting."
    3. C"The tube is just a standard procedure before many types of surgery to the abdomen."
    4. D"The tube will let us measure your stomach contents so that we can plan what type of IV fluid replacement would be best."
23. 23A 61-year-old patient with suspected bowel obstruction had a nasogastric tube inserted at 4:00 AM. The nurse shares in the morning report that the day shift staff should check the tube for patency at what times?

    1. A7:00 AM, 10:00 AM, and 1:00 PM
    2. B8:00 AM, 12:00 PM, and 4:00 PM
    3. C9:00 AM and 3:00 PM
    4. D9:00 AM, 12:00 PM, and 3:00 PM
24. 24A colectomy is scheduled for a 38-year-old woman with ulcerative colitis. The nurse should plan to include what prescribed measure in the preoperative preparation of this patient?

    1. AInstruction on irrigating a colostomy
    2. BAdministration of a cleansing enema
    3. CA high-fiber diet the day before surgery
    4. DAdministration of IV antibiotics for bowel preparation
25. 25What information would have the highest priority to be included in preoperative teaching for a 68-year-old patient scheduled for a colectomy?

    1. AHow to care for the wound
    2. BHow to deep breathe and cough
    3. CThe location and care of drains after surgery
    4. DWhich medications will be used during surgery
26. 26The nurse asks a 68-year-old patient scheduled for colectomy to sign the operative permit as directed in the physician's preoperative orders. The patient states that the physician has not really explained very well what is involved in the surgical procedure. What is the most appropriate action by the nurse?

    1. AAsk family members whether they have discussed the surgical procedure with the physician.
    2. BHave the patient sign the form and state the physician will visit to explain the procedure before surgery.
    3. CExplain the planned surgical procedure as well as possible and have the patient sign the consent form.
    4. DDelay the patient's signature on the consent and notify the physician about the conversation with the patient.
27. 27Two days following a colectomy for an abdominal mass, a patient reports gas pains and abdominal distention. The nurse plans care for the patient based on the knowledge that the symptoms are occurring as a result of

    1. Aimpaired peristalsis.
    2. Birritation of the bowel.
    3. Cnasogastric suctioning.
    4. Dinflammation of the incision site.
28. 28Following bowel resection, a patient has a nasogastric (NG) tube to suction, but complains of nausea and abdominal distention. The nurse irrigates the tube as necessary as ordered, but the irrigating fluid does not return. What should be the priority action by the nurse?

    1. ANotify the physician.
    2. BAuscultate for bowel sounds.
    3. CReposition the tube and check for placement.
    4. DRemove the tube and replace it with a new one.
29. 29The nurse is caring for a postoperative patient with a colostomy. The nurse is preparing to administer a dose of famotidine (Pepcid) when the patient asks why the medication was ordered since the patient does not have a history of heartburn or gastroesophageal reflux disease (GERD). What response by the nurse would be the most appropriate?

    1. A"This will prevent air from accumulating in the stomach, causing gas pains."
    2. B"This will prevent the heartburn that occurs as a side effect of general anesthesia."
    3. C"The stress of surgery is likely to cause stomach bleeding if you do not receive it."
    4. 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."
30. 30A stroke patient who primarily uses a wheelchair for mobility has diarrhea with fecal incontinence. What should the nurse assess first?

    1. AFecal impaction
    2. BPerineal hygiene
    3. CDietary fiber intake
    4. DAntidiarrheal agent use
31. 31The wound, ostomy, and continence (WOC) nurse selects the site where the ostomy will be placed. What should be included in the consideration for the site?

    1. AThe patient must be able to see the site.
    2. BOutside the rectus muscle area is the best site.
    3. CIt is easier to seal the drainage bag to a protruding area.
    4. DThe ostomy will need irrigation, so area should not be tender.
32. 32When evaluating the patient's understanding about the care of the ileostomy, what statement by the patient indicates the patient needs more teaching?

    1. A"I will be able to regulate when I have stools."
    2. B"I will be able to wear the pouch until it leaks."
    3. C"Dried fruit and popcorn must be chewed very well."
    4. D"The drainage from my stoma can damage my skin."
33. 33When teaching the patient about the diet for diverticular disease, which foods should the nurse recommend?

    1. AWhite bread, cheese, and green beans
    2. BFresh tomatoes, pears, and corn flakes
    3. COranges, baked potatoes, and raw carrots
    4. DDried beans, All Bran (100%) cereal, and raspberries

Descripción

Bellevue college ADN

Autor

elizabeth cobb

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English

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