Test Bank for Dewit's Medical-Surgical Nursing: Concepts and Practice, 4th Edition by Holly Stromberg, Verified Chapters 1-49

Dewit’s Medical Surgical Nursing Concepts And Practice 4th Edition Stromberg Test Bank

Chapter 27: The Gastrointestinal System deWit: Medical-Surgical Nursing: Concepts & Practice, 4th Edition MULTIPLE CHOICE 1. The nurse cautions that constant stress can cause which alteration to the gastrointestinal (GI) system? a. Slowed GI mobility resulting in constipation b. Reversed peristalsis resulting in projectile vomiting c. Increased digestive juices resulting in a gastric ulcer d. Decreased digestive juices resulting in ineffective metabolism ANS: C Stress increases the gastric secretions, which irritate and finally ulcerate the gastric mucosal lining. PTS: 1 DIF: Cognitive Level: Comprehension REF: 627 OBJ: 2 (theory) TOP: Stress: Gastric Ulcer KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance 2. The nurse is caring for multiple patients. The nurse determines that which patient has the highest risk for developing gallstones? a. A 37-year-old white man of normal weight on long-term corticosteroids for asthma. b. A 42-year-old African American man of normal weight who has smoked for 25 years. c. A 46-year-old Indonesian woman who is under normal weight and has recently had radiation treatments. d. A 50-year-old obese Mexican American woman who has type 1 diabetes. ANS: D Obesity, diabetes mellitus (DM), rapid weight loss, and Crohn disease increase the risk for the development of gallstones. Native Americans and Mexican Americans have an ethnic predisposition to gallstones. PTS: 1 DIF: Cognitive Level: Analysis REF: 628 OBJ: 1 (theory) TOP: Gallstones: Risk Factors KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance 3. The home health nurse is caring for the patient with tuberculosis who is taking rifampin and isoniazid (INH). The nurse should carefully monitor the patient for which potential side effect? a. Gallstones b. Liver disorders c. Bleeding ulcers d. Esophagitis ANS: B Rifampin and INH are both hepatotoxic. PTS: 1 DIF: Cognitive Level: Application REF: 629 OBJ: 2 TOP: Liver Disorders: Etiology KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological Therapies 4. The nurse is obtaining a history of a patient with hepatitis A. Which question is most appropriate for the nurse to ask? a. “If using drugs, do you share needles?” b. “Do you always practice safe sex?” c. “Have you traveled to Canada in the last month?” d. “Do you eat shellfish or oysters often?” ANS: D Shellfish and mollusks can be contaminated by living in feces-contaminated water. Drug use and unprotected sex are not part of the etiology of hepatitis A but are for hepatitis B. Travel to Canada is not associated with hepatitis A. PTS: 1 DIF: Cognitive Level: Application REF: 629, Health Promotion OBJ: 1 (clinical) TOP: Hepatitis A: Etiology KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance 5. The nurse is caring for a patient who complains, “I don’t see why I can’t have a CT scan instead of the expensive MRI!” Which response is most appropriate for the nurse to make? a. “The MRI provides better contrast between normal and pathologic tissue.” b. “The MRI requires less analysis and is easier to read.” c. “The MRI produces a digital image that can be transmitted via e-mail.” d. “The MRI exposes the patient to less radiation.” ANS: A Magnetic resonance imaging (MRI) uses radiofrequency signals to determine how hydrogen atoms behave in the magnetic field. In addition, the MRI provides a better contrast than computed tomography (CT) between healthy tissues and pathologic tissues. PTS: 1 DIF: Cognitive Level: Comprehension REF: 631, Table 27-1 OBJ: 4 TOP: MRI: Advantages KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Basic Care and Comfort 6. The nurse is preparing to administer liquid laxative to a patient in preparation for a colonoscopy. Which action should the nurse take? a. Offer a small snack. b. Take the patient’s temperature. c. Mix the laxative with orange juice. d. Chill the laxative and pour it over ice. ANS: D Chilling the laxative or pouring it over ice makes the drink more palatable and easier to swallow. The nurse should not offer any food, as the accuracy of the test depends on adequate bowel prep. The laxative does not affect the patient’s temperature. Mixing the laxative with another substance can make it difficult to judge how much the patient actually consumed if any liquid is remaining. PTS: 1 DIF: Cognitive Level: Application REF: 629 OBJ: 4 TOP: Oral Laxative: Techniques of Administration KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential 7. The nurse caring for an 80-year-old woman who is undergoing the extensive bowel preparation for a colonoscopy. The nurse should most closely monitor the patient for which potential complication? a. Diarrhea b. Metabolic acidosis c. Fatigue d. Dyspnea ANS: B The older patient is especially at risk for problems of electrolyte imbalance, fluid overload, or dehydration when undergoing preparation for diagnostic tests that require a fasting state and/or bowel cleansing. Metabolic acidosis can occur when there is a large volume loss of bowel content. Bowel preparation causes diarrhea and may cause fatigue; bowel preparation should not cause dyspnea. a. 30 seconds b. 1 minute c. 2 minutes PTS: 1 DIF: Cognitive Level: Understanding REF: 629, Older Adult Care Points OBJ: 4 TOP: Bowel Preparation: Side Effects KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance 8. The nurse is caring for a patient who returns to the floor at lunch time after undergoing an upper GI (UGI series). Which action is most important for the nurse to perform first? a. Administer a laxative. b. Educate the patient about the possibility of white stools. c. Offer the patient a small snack. d. Provide oral care. ANS: A The contrast media used in the series features barium that can harden and lead to an impaction. Patients should have a bowel movement quickly after the procedure to eliminate the medium from the body. While fluids and snacks or meal trays should be given as quickly as possible, patients should be educated about the possibility of white stools for several days postprocedure, and oral care should be provided, these interventions are of lesser importance since they do not directly work to quickly prevent a postprocedure complication. PTS: 1 DIF: Cognitive Level: Analysis REF: 630, Table 27-1 OBJ: 4 TOP: UGI Series: Aftercare KEY: MSC: Nursing Process Step: Implementation NCLEX: Physiological Integrity: Basic Care and Comfort 9. The nurse is assessing a patient’s bowel sounds. After auscultating each quadrant for 30 seconds, the nurse fails to hear any sounds. How should the nurse document this finding? a. Absent bowel sounds b. Hypoactive bowel sounds c. Active bowel sounds d. Hyperactive bowel sounds ANS: B Hypoactive bowel sounds can be noted in the medical record when no sounds are heard after listening in each of the four quadrants for 30 seconds. For bowel sounds to be considered absent, it is necessary to verify that no sounds are heard after listening in each of the four quadrants for 5 minutes. If hyperactive, high-pitched sounds are heard in one quadrant, and decreased sounds are heard in another quadrant, assess for nausea and vomiting, as the patient may have an intestinal obstruction. PTS: 1 DIF: Cognitive Level: Comprehension REF: 636, Clinical Cues OBJ: 1 (clinical) TOP: Bowel Sounds: Assessment KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance 10. When assessing a patient’s bowel sounds, nurse auscultates loud bowel sounds in each quadrant every 3 seconds. The nurse understands that these findings could indicate that the patient is experiencing which condition? a. Diarrhea b. Paralytic ileus c. Vomiting d. Constipation ANS: A Loud, rapid bowel sounds are indicative of hypermobility, which could result in diarrhea. Absent bowel sounds are associated with paralytic ileus. Normal bowel sounds present as soft gurgles and clicks every 5 to 15 seconds. Hypoactive bowel sounds indicate decreased motility and could indicate that the patient is constipated? PTS: 1 DIF: Cognitive Level: Application REF: 636 OBJ: 1 (clinical) TOP: Bowel Sounds: Assessment KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance 11. The nurse is reviewing a student nurse’s charting and notes that the student has documented absent bowel sounds. The nurse reminds the student that in order to document absent bowel sounds, one must auscultate each quadrant at what period of time?