Professional Documents
Culture Documents
1. A fecalith
2. Bowel kinking
3. Internal bowel occlusion
4. Abdominal bowel swelling
2. Which of the following terms best describes the pain associated with
appendicitis?
1. Aching
2. Fleeting
3. Intermittent
4. Steady
1. Milk
2. Bicarbonate of soda, or baking soda
3. Enteric coated aspirin
4. Nonsteriodal anti-imflammatory drugs
1. Low-fiber diet
2. High-fiber diet
3. High-protein diet
4. Low-carbohydrate diet
1. No symptoms exist
2. Change in bowel habits
3. Anorexia with low-grade fever
4. Episodic, dull, or steady midabdominal pain
1. Abdominal ultrasound
2. Barium enema
3. Barium swallow
4. Gastroscopy
13. Which area of the alimentary canal is the most common location for
Crohns disease?
1. Ascending colon
2. Descending colon
3. Sigmoid colon
4. Terminal ileum
1. Constipation
2. Diet
3. Hereditary
4. Lack of exercise
1. Acidic diet
2. Altered immunity
3. Chronic constipation
4. Emotional stress
16. Fistulas are most common with which of the following bowel disorders?
1. Crohns disease
2. Diverticulitis
3. Diverticulosis
4. Ulcerative colitis
17. Which of the following areas is the most common site of fistulas in
clients with Crohns disease?
1. Anorectal
2. Ileum
3. Rectovaginal
4. Transverse colon
18. Which of the following associated disorders may a client with ulcerative
colitis exhibit?
1. Gallstones
2. Hydronephrosis
3. Nephrolithiasis
4. Toxic megacolon
19. Which of the following associated disorders may the client with Crohns
disease exhibit?
1. Ankylosing spondylitis
2. Colon cancer
3. Malabsorption
4. Lactase deficiency
1. Dumping syndrome
2. Rectal bleeding
3. Soft stools
4. Fistulas
1. Gastritis
2. Bowel herniation
3. Bowel outpouching
4. Bowel perforation
1. Acetaminophen
2. Opiates
3. Steroids
4. Stool softeners
27. During the first few days of recovery from ostomy surgery for ulcerative
colitis, which of the following aspects should be the first priority of client
care?
1. Body image
2. Ostomy care
3. Sexual concerns
4. Skin care
28. Colon cancer is most closely associated with which of the following
conditions?
1. Appendicitis
2. Hemorrhoids
3. Hiatal hernia
4. Ulcerative colitis
1. Abdominal CT scan
2. Abdominal x-ray
3. Colonoscopy
4. Fecal occult blood test
31. Radiation therapy is used to treat colon cancer before surgery for which
of the following reasons?
1. A change in appetite
2. A change in bowel habits
3. An increase in body weight
4. An increase in body temperature
33. A client has just had surgery for colon cancer. Which of the following
disorders might the client develop?
1. Peritonitis
2. Diverticulosis
3. Partial bowel obstruction
4. Complete bowel obstruction
34. A client with gastric cancer may exhibit which of the following
symptoms?
1. Abdominal cramping
2. Constant hunger
3. Feeling of fullness
4. Weight gain
1. Barium enema
2. Colonoscopy
3. Gastroscopy
4. Serum chemistry levels
36. A client with gastric cancer can expect to have surgery for resection.
Which of the following should be the nursing management priority for the
preoperative client with gastric cancer?
1. Discharge planning
2. Correction of nutritional deficits
3. Prevention of DVT
4. Instruction regarding radiation treatment
37. Care for the postoperative client after gastric resection should focus on
which of the following problems?
1. Body image
2. Nutritional needs
3. Skin care
4. Spiritual needs
1. Constipation
2. Dumping syndrome
3. Gastric spasm
4. Intestinal spasms
39. A client with rectal cancer may exhibit which of the following
symptoms?
1. Abdominal fullness
2. Gastric fullness
3. Rectal bleeding
4. Right upper quadrant pain
40. A client with which of the following conditions may be likely to develop
rectal cancer?
1. Adenomatous polyps
2. Diverticulitis
3. Hemorrhoids
4. Peptic ulcer disease
41. Which of the following treatments is used for rectal cancer but not for
colon cancer?
1. Chemotherapy
2. Colonoscopy
3. Radiation
4. Surgical resection
1. Cholelithiasis
2. Gastritis
3. Perforated ulcer
4. Incarcerated hernia
43. Which of the following symptoms would a client in the early stages of
peritonitis exhibit?
1. Abdominal distention
2. Abdominal pain and rigidity
3. Hyperactive bowel sounds
4. Right upper quadrant pain
1. Broad-spectrum antibiotics
2. Electrolyte replacement
3. I.V. fluids
4. Regular diet
47. A client with irritable bowel syndrome is being prepared for discharge.
Which of the following meal plans should the nurse give the client?
1. Low fiber, low-fat
2. High fiber, low-fat
3. Low fiber, high-fat
4. High-fiber, high-fat
48. A client presents to the emergency room, reporting that he has been
vomiting every 30 to 40 minutes for the past 8 hours. Frequent vomiting
puts him at risk for which of the following?
54. After a right hemicolectomy for treatment of colon cancer, a 57-year old
client is reluctant to turn while on bed rest. Which action by the nurse
would be appropriate?
1. Asking a coworker to help turn the client
2. Explaining to the client why turning is important.
3. Allowing the client to turn when hes ready to do so
4. Telling the client that the physicians order states he must turn every 2 hours
1. Semi-Fowlers
2. Supine
3. Reverse Trendelenburg
4. High Fowlers
57. The client being seen in a physicians office has just been scheduled for
a barium swallow the next day. The nurse writes down which of the
following instructions for the client to follow before the test?
59. The nurse is preparing a discharge teaching plan for the client who had
an umbilical hernia repair. Which of the following would the nurse include
in the plan?
1. Bloody diarrhea
2. Hypotension
3. A hemoglobin of 12 mg/dL
4. Rebound tenderness
61. The nurse is reviewing the record of a client with Crohns disease.
Which of the following stool characteristics would the nurse expect to note
documented on the clients record?
1. Chronic constipation
2. Diarrhea
3. Constipation alternating with diarrhea
4. Stool constantly oozing from the rectum
63. The nurse is teaching the client how to perform a colostomy irrigation.
To enhance the effectiveness of the irrigation and fecal returns, what
measure should the nurse instruct the client to do?
64. The nurse is reviewing the physicians orders written for a client
admitted with acute pancreatitis. Which physician order would the nurse
question if noted on the clients chart?
1. NPO status
2. Insert a nasogastric tube
3. An anticholinergic medication
4. Morphine for pain
65. The nurse is doing an admission assessment on a client with a history
of duodenal ulcer. To determine whether the problem is currently active, the
nurse would assess the client for which of the following most frequent
symptom(s) of duodenal ulcer?
66. The nurse instructs the ileostomy client to do which of the following as
a part of essential care of the stoma?
67. The client who has undergone creation of a colostomy has a nursing
diagnosis of Disturbed body image. The nurse would evaluate that the
client is making the most significant progress toward identified goals if the
client:
68. The nurse is assessing for stoma prolapse in a client with a colostomy.
The nurse would observe which of the following if stoma prolapse
occurred?
1. Sunken and hidden stoma
2. Dark- and bluish-colored stoma
3. Narrowed and flattened stoma
4. Protruding stoma
69. The client with a new colostomy is concerned about the odor from the
stool in the ostomy drainage bag. The nurse teaches the client to include
which of the following foods in the diet to reduce odor?
1. Yogurt
2. Broccoli
3. Cucumbers
4. Eggs
70. The nurse has given instructions to the client with an ileostomy about
foods to eat to thicken the stool. The nurse determines that the client needs
further instructions if the client stated to eat which of the following foods to
make the stools less watery?
1. Pasta
2. Boiled rice
3. Bran
4. Low-fat cheese
71. The client has just had surgery to create an ileostomy. The nurse
assesses the client in the immediate post-op period for which of the
following most frequent complications of this type of surgery?
1. Intestinal obstruction
2. Fluid and electrolyte imbalance
3. Malabsorption of fat
4. Folate deficiency
72. The nurse is doing pre-op teaching with the client who is about to
undergo creation of a Kock pouch. The nurse interprets that the client has
the best understanding of the nature of the surgery if the client makes
which of the following statements?
73. The client with a colostomy has an order for irrigation of the colostomy.
The nurse used which solution for irrigation?
1. Distilled water
2. Tap water
3. Sterile water
4. Lactated Ringers
1. Administer dilaudid
2. Notify the physician
3. Call and ask the operating room team to perform the surgery as soon as
possible
4. Reposition the client and apply a heating pad on a warm setting to the clients
abdomen.
75. The client has been admitted with a diagnosis of acute pancreatitis. The
nurse would assess this client for pain that is:
1. Severe and unrelenting, located in the epigastric area and radiating to the
back.
2. Severe and unrelenting, located in the left lower quadrant and radiating to the
groin.
3. Burning and aching, located in the epigastric area and radiating to the
umbilicus.
4. Burning and aching, located in the left lower quadrant and radiating to the hip.
76. The client with Crohns disease has a nursing diagnosis of acute pain.
The nurse would teach the client to avoid which of the following in
managing this problem?
78. During the assessment of a clients mouth, the nurse notes the absence
of saliva. The client is also complaining of pain near the area of the ear. The
client has been NPO for several days because of the insertion of a NG tube.
Based on these findings, the nurse suspects that the client is developing
which of the following mouth conditions?
1. Stomatitis
2. Oral candidiasis
3. Parotitis
4. Gingivitis
79. The nurse evaluates the clients stoma during the initial post-op period.
Which of the following observations should be reported immediately to the
physician?
80. When planning care for a client with ulcerative colitis who is
experiencing symptoms, which client care activities can the nurse
appropriately delegate to a unlicensed assistant? Select all that apply.
81. Which goal of the clients care should take priority during the first days
of hospitalization for an exacerbation of ulcerative colitis?
82. A clients ulcerative colitis symptoms have been present for longer than
1 week. The nurse recognizes that the client should be assessed carefully
for signs of which of the following complications?
1. Heart failure
2. DVT
3. Hypokalemia
4. Hypocalcemia
83. A client who has ulcerative colitis has persistent diarrhea. He is thin
and has lost 12 pounds since the exacerbation of his ulcerative colitis. The
nurse should anticipate that the physician will order which of the following
treatment approaches to help the client meet his nutritional needs?
85. When used with hyperacidic disorders of the stomach, antacids are
given to elevate the gastric pH to:
1. 2.0
2. 4.0
3. 6.0
4. >8.0
86. One of your patients is receiving digitalis orally and is also to receive an
antacid at the same time. Your most appropriate action, based on the
pharmacokinetics of antacids, is to:
87. The nurse would teach patients that antacids are effective in treatment
of hyperacidity because they:
1. Neutralize gastric acid
2. Decrease stomach motility
3. Decrease gastric pH
4. Decrease duodenal pH
88. The nurse would monitor for which of the following adverse reactions to
aluminum-containing antacids such as aluminum hydroxide (Amphojel)?
1. Diarrhea
2. Constipation
3. GI upset
4. Fluid retention
89. The nurse would question an order for which type of antacid in patients
with chronic renal failure?
1. Aluminum-containing antacids
2. Calcium-containing antacids
3. Magnesium-containing antacids
4. All of the above.
90. The nurse would monitor a patient using sodium bicarbonate to treat
gastric hyperacidity for signs and symptoms of:
1. Metabolic alkalosis
2. Metabolic acidosis
3. Hyperkalemia
4. Hypercalcemia
1. lansoprazole (Prevacid)
2. omeprazole (Prilosec)
3. pantoprazole (Protonix)
4. esomeprazole (Nexium)
1. 4
2. 6
3. 8
4. 10
1. Decreased GI motility
2. Decreased gastric secretions
3. Increased fluid absorption
4. Binding to diarrhea-causing bacteria for excretion
A fecalith is a fecal calculus, or stone, that occludes the lumen of the appendix
and is the most common cause of appendicitis. Bowel wall swelling, kinking of
the appendix, and external occlusion, not internal occlusion, of the bowel by
adhesions can also be causes of appendicitis.
2. Answer: 4. Steady
The pain begins in the epigastrium or periumbilical region, then shifts to the right
lower quadrant and becomes steady. The pain may be moderate to severe.
Undigested food can block the diverticulum, decreasing blood supply to the area
and predisposing the area to invasion of bacteria. Chronic laxative use is a
common problem in elderly clients, but it doesnt cause diverticulitis. Chronic
constipation can cause an obstructionnot diverticulitis. Herniation of the
intestinal mucosa causes an intestinal perforation.
A barium enema will cause diverticula to fill with barium and be easily seen on x-
ray. An abdominal US can tell more about structures, such as the gallbladder,
liver, and spleen, than the intestine. A barium swallow and gastroscopy view
upper GI structures.
Antibiotics are used to reduce the inflammation. The client isnt typically isnt
allowed anything orally until the acute episode subsides. Parenteral fluids are
given until the client feels better; then its recommended that the client drink eight
8-ounce glasses of water per day and gradually increase fiber in the diet to
improve intestinal motility. During the acute phase, activities that increase intra-
abdominal pressure should be avoided to decrease pain and the chance of
intestinal obstruction.
12. Answer: 4. The small intestine and colon; affecting the entire thickness
of the bowel
Crohns disease can involve any segment of the small intestine, the colon, or
both, affecting the entire thickness of the bowel. Answers 1 and 3 describe
ulcerative colitis, answer 2 is too specific and therefore, not likely.
Studies have shown that the terminal ileum is the most common site for
recurrence in clients with Crohns disease. The other areas may be involved but
arent as common.
Several theories exist regarding the cause of ulcerative colitis. One suggests
altered immunity as the cause based on the extraintestinal characteristics of the
disease, such as peripheral arthritis and cholangitis. Diet and constipation have
no effect on the development of ulcerative colitis. Emotional stress can
exacerbate the attacks but isnt believed to be the primary cause.
The lesions of Crohns disease are transmural; that is, they involve all thickness
of the bowel. These lesions may perforate the bowel wall, forming fistulas with
adjacent structures. Fistulas dont develop in diverticulitis or diverticulosis. The
ulcers that occur in the submucosal and mucosal layers of the intestine in
ulcerative colitis usually dont progress to fistula formation as in Crohns disease.
Fistulas occur in all these areas, but the anorectal area is most common because
of the relative thinness of the intestinal wall in this area.
In ulcerative colitis, rectal bleeding is the predominant symptom. Soft stools are
more commonly associated with Crohns disease, in which malabsorption is more
of a problem. Dumping syndrome occurs after gastric surgeries. Fistulas are
associated with Crohns disease.
A colonoscopy with biopsy can be performed to determine the state of the colons
mucosal layers, presence of ulcerations, and level of cytologic development. An
abdominal x-ray or CT scan wouldnt provide the cytologic information necessary
to diagnose which disease it is. A barium swallow doesnt involve the intestine.
A decrease in body weight may occur during therapy due to inadequate dietary
intake, but isnt related to antibiotic therapy. Effective antibiotic therapy will be
noted by a decrease in temperature, number of stools, and bleeding.
25. Answer: 4. Bowel perforation
The pain with irritable bowel disease is caused by inflammation, which steroids
can reduce. Stool softeners arent necessary. Acetaminophen has little effect on
the pain, and opiate narcotics wont treat its underlying cause.
Although all of these are concerns the nurse should address, being able to safely
manage the ostomy is crucial for the client before discharge.
Radiation therapy is used to treat colon cancer before surgery to reduce the size
of the tumor, making it easier to be resected. Radiation therapy isnt curative,
cant eliminate the malignant cells (though it helps define tumor margins), can
could slow postoperative healing.
The most common complaint of the client with colon cancer is a change in bowel
habits. The client may have anorexia, secondary abdominal distention, or weight
loss. Fever isnt associated with colon cancer.
The client with gastric cancer may report a feeling of fullness in the stomach, but
not enough to cause him to seek medical attention. Abdominal cramping isnt
associated with gastric cancer. Anorexia and weight loss (not increased hunger
or weight gain) are common symptoms of gastric cancer.
35. Answer: 3. Gastroscopy
Clients with gastric cancer commonly have nutritional deficits and may be
cachectic. Discharge planning before surgery is important, but correcting the
nutrition deficit is a higher priority. At present, radiation therapy hasnt been
proven effective for gastric cancer, and teaching about it preoperatively wouldnt
be appropriate. Prevention of DVT also isnt a high priority to surgery, though it
assumes greater importance after surgery.
A client with adenomatous polyps has a higher risk for developing rectal cancer
than others do. Clients with diverticulitis are more likely to develop colon cancer.
Hemorrhoids dont increase the chance of any type of cancer. Clients with peptic
ulcer disease have a higher incidence of gastric cancer.
A client with rectal cancer can expect to have radiation therapy in addition to
chemotherapy and surgical resection of the tumor. A colonoscopy is performed to
diagnose the disease. Radiation therapy isnt usually indicated in colon cancer.
The most common cause of peritonitis is a perforated ulcer, which can pour
contaminates into the peritoneal cavity, causing inflammation and infection within
the cavity. The other conditions dont by themselves cause peritonitis. However,
if cholelithiasis leads to rupture of the gallbladder, gastritis leads to erosion of the
stomach wall, or an incarcerated hernia leads to rupture of the intestines,
peritonitis may develop.
Because of infection, the clients WBC count will be elevated. A hemoglobin level
below 10 mg/dl may occur from hemorrhage. A PT time longer than 100 seconds
may suggest disseminated intravascular coagulation, a serious complication of
septic shock. A potassium level above 5.5 mEq/L may indicate renal failure.
The client with peritonitis usually isnt allowed anything orally until the source of
peritonitis is confirmed and treated. The client also requires broad-spectrum
antibiotics to combat the infection. I.V. fluids are given to maintain hydration and
hemodynamic stability and to replace electrolytes.
Peritonitis can advance to shock and circulatory failure, so fluid and electrolyte
balance is the priority focus of nursing management. Gastric irrigation may be
needed periodically to ensure patency of the nasogastric tube. Although pain
management is important for comfort and psychosocial care will address
concerns such as anxiety, focusing on fluid and electrolyte imbalance will
maintain hemodynamic stability.
The client with irritable bowel syndrome needs to be on a diet that contains at
least 25 grams of fiber per day. Fatty foods are to be avoided because they may
precipitate symptoms.
48. Answer: 4. Metabolic alkalosis with hypokalemia
Gastric acid contains large amounts of potassium, chloride, and hydrogen ions.
Excessive loss of these substances, such as from vomiting, can lead to metabolic
alkalosis and hypokalemia.
Fluid shifts to the site of the bowel obstruction, causing a fluid deficit in the
intravascular spaces. If the obstruction isnt resolved immediately, the client may
experience an imbalanced nutritional status (less than body requirements);
however, deficient fluid volume takes priority. The client may also experience
pain, but that nursing diagnosis is also of lower priority than deficient fluid
volume.
Exercise helps prevent constipation. Fluids and dietary fiber promote normal
bowel function. The client should drink eight to ten glasses of fluid each day.
Although adding bran to cereal helps prevent constipation by increasing dietary
fiber, the client should start with a small amount and gradually increase the
amount as tolerated to a maximum of 2 grams a day.
A client with diarrhea has a nursing diagnosis of Deficient fluid volume related to
excessive fluid loss in the stool. Expected outcomes include firm skin turgor,
moist mucous membranes, and urine output of at least 30 ml/hr. The client also
has a nursing diagnosis of diarrhea, with expected outcomes of passage of
formed stools at regular intervals and a decrease in stool frequency and liquidity.
The client is at risk for impaired skin integrity related to irritation from diarrhea;
expected outcomes for this diagnosis include absence of erythema in perianal
skin and mucous membranes and absence of perianal tenderness or burning.
52. Answer: 1. Limit fat intake to 20% to 25% of your total daily calories.
To help prevent colon cancer, fats should account for no more than 20% to 25%
of total daily calories and the diet should include 25 to 30 grams of fiber per day.
A digital rectal examination isnt recommended as a stand-alone test for
colorectal cancer. For colorectal cancer screening, the American Cancer society
advises clients over age 50 to have a flexible sigmoidoscopy every 5 years,
yearly fecal occult blood tests, yearly fecal occult blood tests PLUS a flexible
sigmoidoscopy every 5 years, a double-contrast barium enema every 5 years, or
a colonoscopy every 10 years.
A barium swallow is an x-ray study that uses a substance called barium for
contrast to highlight abnormalities in the GI tract. The client should fast for 8 to 12
hours before the test, depending on the physician instructions. Most oral
medications also are withheld before the test. After the procedure the nurse must
monitor for constipation, which can occur as a result of the presence of barium in
the GI tract.
Bedrest is not required following this surgical procedure. The client should take
analgesics as needed and as prescribed to control pain. A drain is not used in
this surgical procedure, although the client may be instructed in simple dressing
changes. Coughing is avoided to prevent disruption of the tissue integrity, which
can occur because of the location of this surgical procedure.
To enhance effectiveness of the irrigation and fecal returns, the client is instructed
to increase fluid intake and prevent constipation.
The most frequent symptom of duodenal ulcer is pain that is relieved by food
intake. These clients generally describe the pain as burning, heavy, sharp, or
hungry pain that often localizes in the midepigastric area. The client with
duodenal ulcer usually does not experience weight loss or N/V. These symptoms
are usually more typical in the client with a gastric ulcer.
The peristomal skin must receive meticulous cleansing because the ileostomy
drainage has more enzymes and is more caustic to the skin than colostomy
drainage. Foods such as nuts and those with seeds will pass through the
ileostomy. The client should be taught that these foods will remain undigested.
The area below the ileostomy may be massaged if needed if the ileostomy
becomes blocked by high fiber foods. Fluid intake should be maintained to at
least six to eight glasses of water per day to prevent dehydration.
The client is expected to have a body image disturbance after colostomy. The
client progresses through normal grieving stages to adjust to this change. The
client demonstrates the greatest deal of acceptance when the client participates
in the actual colostomy care. Each of the incorrect options represents an interest
in colostomy care but is a passive activity. The correct option shows the client is
participating in self-care.
The client should be taught to include deodorizing foods in the diet, such a beet
greens, parsley, buttermilk, and yogurt. Spinach also reduces odor but is a gas
forming food as well. Broccoli, cucumbers, and eggs are gas forming foods.
Foods that help thicken the stool of the client with an ileostomy include pasta,
boiled rice, and low-fat cheese. Bran is high in dietary fiber and thus will increase
output of watery stool by increasing propulsion through the bowel. Ileostomy
output is liquid. Addition or elimination of various foods can help thicken or loosen
this liquid drainage.
A major complication that occurs most frequent following an ileostomy is fluid and
electrolyte imbalance. The client requires constant monitoring of intake and
output to prevent this from happening. Losses require replacement by
intravenous infusion until the client can tolerate a diet orally. Intestinal obstruction
is a less frequent complication. Fat malabsorption and folate deficiency are
complications that could occur later in the postoperative period.
72. Answer: 1. I will need to drain the pouch regularly with a catheter.
A Kock pouch is a continent ileostomy. As the ileostomy begins to function, the
client drains it every 3 to 4 hours and then decreases the draining to about 3
times a day or as needed when full. The client does not need to wear a drainage
bag but should wear an absorbent dressing to absorb mucus drainage from the
stoma. Ileostomy drainage is liquid. The client would be able to pass stool only
from the rectum if an ileal-anal pouch or anastomosis were created. This type of
operation is a two-stage procedure.
Warm tap water or saline solution is used to irrigate a colostomy. If the tap water
is not suitable for drinking, then bottled water should be used.
Based on the signs and symptoms presented in the question, the nurse should
suspect peritonitis and should notify the physician. Administering pain medication
is not an appropriate intervention. Heat should never be applied to the abdomen
of a client with suspected appendicitis. Scheduling surgical time is not within the
scope of nursing practice, although the physician probably would perform the
surgery earlier than the prescheduled time.
75. Answer: 1. Severe and unrelenting, located in the epigastric area and
radiating to the back.
The pain associated with acute pancreatitis is often severe and unrelenting, is
located in the epigastric region, and radiates to the back.
The lack of saliva, pain near the area of the ear, and the prolonged NPO status of
the client should lead the nurse to suspect the development of parotitis, or
inflammation of the parotid gland. Parotitis usually develops in cases of
dehydration combined with poor oral hygiene or when clients have been NPO for
an extended period. Preventative measures include the use of sugarless hard
candy or gum to stimulate saliva production, adequate hydration, and frequent
mouth care. Stomatitis (inflammation of the mouth) produces excessive salivation
and a sore mouth.
A dark red to purple stoma indicates inadequate blood supply. Mild edema and
slight oozing of blood are normal in the early post-op period. The colostomy
would typically not begin functioning until 2-4 days after surgery.
80. Answer: 2, 4, and 5.
The nurse can delegate the following basic care activities to the unlicensed
assistant: providing skin care following bowel movements, maintaining intake and
output records, and obtaining the clients weight. Assessing the clients bowel
sounds and evaluating the clients response to medication are registered nurse
activities that cannot be delegated.
Food will be withheld from the client with severe symptoms of ulcerative colitis to
rest the bowel. To maintain the clients nutritional status, the client will be started
on TPN. Enteral feedings or dividing the diet into 6 small meals does not allow
the bowel to rest. A high-calorie, high-protein diet will worsen the clients
symptoms.
84. Answer: 2. Decreased absorption of digoxin
86. Answer: 4. Contact the physician regarding the drug interaction and
request a change in the time of dosing of the drugs.
Antacids work by neutralizing gastric acid, which would cause an increase in pH.
They do not affect gastric motility.
92. Answer: 1. Compete with histamine for binding sites on the parietal
cells
Because the proton pump inhibitors stop the final step of acid secretion, they can
block up to 90% of acid secretion, leading to achlorhydria (without acid).
Pantoprazole is the only proton pump inhibitor that is available for intravenous
administration. The other medications in this category may only be administered
orally.
97. Answer: 3. 8
Side effects associated with loperamide include CNS fatigue and dizziness,
epigastric pain, abdominal cramps, nausea, dry mouth, vomiting, and anorexia.
Diarrhea is an indication, not a side effect.