Febuary Questions:

1. Which of the following assessments is essential for the nurse to make when caring for a client who has just had an esophagogastroduodenoscopy (EGD)?
a. Auscultate bowel sounds
b. Check gag reflex
c. Monitor salivary pH
d. Measure abdominal girth

2. A client has a nasogastric (NG) tube in place for gastric decompression and complains of increasing nausea. Which action should the nurse take first?
a. Advance the tube 2 cm
b. Place client in a recumbent position
c. Instill 20 mL of saline
d. Obtain abdominal x-ray to assess placement

3. A client with a subtotal gastrectomy is scheduled for discharge. Which of these instructions should the nurse give the client to reduce the possibility of dumping syndrome?
a. "Be sure to eat foods high in complex carbohydrates."
b. "It is helpful to take a walk after eating."
c. "Avoid drinking fluids with your meal."
d. "Don't lie down for at least 2 hours after eating."

4. A 32-year-old client is admitted to the hospital with a body mass index (BMI) of 25. The nurse interprets this to mean:
a. The client is undernourished.
b. The client has an optimal amount of body fat.
c. The client is 10 percent overweight.
d. The client is morbidly obese.

5. The nurse teaches the client with gastroesophageal reflux disease (GERD) about ways to minimize symptoms. Which of the following statements made by the client indicates that more teaching is needed?
a. "I will be sure to drink tea instead of coffee."
b. "I will take a walk after I eat."
c. "I will try to eat smaller meals more frequently."
d. "I will sleep with the head of the bed elevated about 12 inches."

6.The client with a gastric ulcer is admitted to the hospital. The nurse should assess the client for intake of which of these substances that increases the risk of developing a gastric ulcer?
a. Aspirin
b. Spicy foods
c. Acetaminophen (Tylenol)
d. Coffee

7. The client with gastroesophageal reflux disease (GERD) is prescribed famotidine (Pepcid). In order to provide effective teaching, the nurse must have which of these understandings about the action of the drug?
a. The drug improves gastric motility.
b. The drug coats the distal portion of the esophagus.
c. The drug increases LES tone.
d. The drug decreases the secretion of gastric acid.

8. The client is admitted to the hospital with ulcerative colitis. The nurse should assess the client for which complication of the disease?
a. Anemia
b. Steatorrhea
c. Cholelithiasis
d. Thrombocytopenia

9. The nurse is developing a health promotion program for intestinal health. Which of the following pieces of information should the nurse include in the program?
a. The addition of dietary fiber can reduce the risk of diverticulosis.
b. A diet high in fat increases the risk of developing Crohn's disease.
c. Irritable bowel syndrome is caused by a deficiency in soluble fiber.
d. Laxatives can improve motility and bowel health.

10. A client is admitted to the hospital with a bowel obstruction. Which of these findings by the nurse would indicate that the obstruction is in the early stages?
a. High-pitched tinkling bowel sounds
b. Low rumbling bowel sounds
c. No bowel sounds aucultated
d. Normal bowel sounds heard in all four quadrants

11.An older client with a nursing diagnosis of Imbalanced Nutrition: Less Than Body Requirements related to chemotherapy has orders for insertion of a nasogastric feeding tube and continuous tube feedings. All of the following nursing actions will be included in the client’s care. Which action will be best to delegate to an LPN?
A. Checking the residual volume every 4 hours
B. Monitoring for signs and symptoms of pneumonia
C. Teaching about the purpose of the enteral feeding
D. Assessing nutritional parameters every 3 days

12. An RN who usually works on the pediatric unit is "floated" to the medical-surgical unit. Which of these clients will be most appropriate for the charge nurse to assign to the float?
A.A 20-year-old client with anorexia nervosa who is receiving total parenteral nutrition through a central venous line
B.A 35-year-old client who had a laparoscopic gastroplasty the previous day and is taking sips of clear liquids
C.A 60-year-old client with gastric cancer who is receiving elemental feedings through a jejunostomy tube
D.A 65-year-old client who has morbid obesity and requires preoperative bariatric surgery assessment

13. Sally is a 17-year-old senior getting ready for her high school graduation. Her best friend has brought her to the school nurse because she is afraid that her friend has been eating and purging. She has suspected this behavior for some time, but her friend adamantly denied it. When she caught Sally getting sick in the school bathroom, she decided to take action. Select all possible consequences or complications that Sally may exhibit as a result of her malnutrition. (More than one choice may be slected)
A.Cachexia
B.Lethargy
C.Intolerance to heat
D.Dermatitis
E.Poor wound healing

14.Claudia is a 34-year-old woman who is about to be discharged from the hospital following gastric bypass surgery. Which statement demonstrates the need for further teaching regarding possible complications following gastric bypass surgery?
A.“I no longer need to wear my abdominal binder.”
B.“I should continue to use my CPAP machine at night.”
C.“I should eat six small meals per day.”
D.“Nausea, diarrhea, and abdominal cramping can all be signs of dumping syndrome.”

15.Michelle has been unsuccessfully trying to lose weight since the birth of her second child. She is currently overweight at 180 lb. She is 5 feet 3 inches tall, with a corresponding BMI of 32. She also suffers from insulin resistance. Which statement demonstrates a good understanding of drug therapy in the management of obesity?
A. Xenical suppresses appetite, which reduces food intake and results in weight loss over time.
B. Meridia is an anorectic drug that inhibits the reuptake of serotonin and norepinephrine.
C. Rimonabant reduces food cravings, but has persistent major gastrointestinal side effects.
D. Orlistat inhibits lipase and can be used indefinitely in the treatment of obesity.

16. Mrs. Williams is being admitted to a nursing home. She is 95 years of age and has been on total parental nutrition (TPN) for some time after several repeated bouts with dehydration and malnutrition. Her family has decided to continue with TPN. Loretta is training a senior level nursing student today. Which assessment, if performed by the student, demonstrates a good understanding of how to prioritize care for this client?
A.Change the intravenous (IV) tubing every 72 hours.
B.Assess the client’s IV site for signs of infection.
C.Change the dressing around the site weekly.
D.Monitor the client’s daily weight.

17. Miss Parker presents to the clinic for a normal checkup before beginning her senior year of high school. Her main complaints include swollen bleeding gums, dry and scaling skin, and dull hair. Her body mass index (BMI) measures 22, her blood pressure 114/68, pulse 72 and regular, RR 22 and nonlabored. Which nutritional assessment would be correct for this client?
A. Her dry and scaling skin is due to a deficiency in vitamin D.
B. Her BMI is consistent with malnutrition.
C. Her bleeding, swollen gums are due to a vitamin C deficiency.
D. Her dull hair has no other cause than being unconditioned.

18. Mr. Pallor has been receiving total enteral nutrition for some time. He is 81 years old and suffering from advanced multiple sclerosis. He lives with his daughter and grandson. He is not suffering from any other health-related issues. The decision has been made to go ahead with total enteral nutrition via a nasogastric tube. Which nursing action would the charge nurse expect to see for this client?
A. For a continuous infusion, the feeding bag and tubing is changed every 48 to 72 hours
B. Check and record the residual volume every 4 hours and then continue with the feeding regardless of the amount of residual.
C. The initial feeding occurs after placement is confirmed by x-ray.
D. A leak in the tubing is corrected by securing the tubing with a piece of tape.

19. A client has a total gastrectomy. The nurse should teach the client about long-term treatment for which of these conditions?
a. Vitamin K deficiency
b. Vitamin B12 deficiency
c. Vitamin A deficiency
d. Vitamin C deficiency

20. A client with suspected duodenal ulcer has an upper GI series with meglumine diatrizoate (Gastrografin). The nurse should inform the client about which of the following side effects of this contrast medium?
a. Diarrhea
b. Peritonitis
c. Flushing
b. Dysuria