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A nurse is caring for four clients on a medical-surgical unit. Which client should the nurse assess first?
A. A client with Crohn’s disease who reports three loose stools during the shift and has a temperature of 99.4°F (37.4°C)
B. A client with GERD who reports burning substernal discomfort after eating a large meal
C. A client with cirrhosis who has increasing abdominal distention and 2+ bilateral lower-extremity edema
D. A client with peptic ulcer disease who suddenly develops severe abdominal pain, a rigid abdomen, and a blood pressure of 88/54 mm Hg
D: 🚨 Severe pain + rigid abdomen + hypotension = possible perforation and shock.
A nurse is developing a plan of care for a client experiencing an acute exacerbation of Crohn’s disease. Which interventions are consistent with the information in the PowerPoint?
Select all that apply.
A. Encourage a low-fiber diet during the acute phase.
B. Encourage foods that are extremely hot or cold to stimulate intestinal activity.
C. Monitor for fluid and electrolyte imbalances.
D. Assess for complications such as fistulas, abscesses, and strictures.
E. Administer prescribed corticosteroids or immunosuppressants.
F. Encourage smoking to reduce stress during exacerbations.
A client with inflammatory bowel disease has been taking sulfasalazine. During a follow-up visit, the nurse reviews the client's laboratory results and assessment findings.
Which finding is the highest priority to report?
A. Mild headache after taking the medication
B. Decreased appetite for 1 day
C. Temperature of 101.8°F (38.8°C) with a sore throat
D. Mild nausea that improves when the medication is taken with food
C.Sulfasalazine can cause agranulocytosis and other blood-cell abnormalities. A fever and sore throat can indicate infection associated with decreased white blood cells and should be reported promptly.
A client is prescribed cimetidine (Tagamet) for peptic ulcer disease. The client takes warfarin, phenytoin, and an antacid.
Which nursing action is most appropriate?
A. Administer all medications together to simplify the schedule.
B. Administer cimetidine with the antacid and monitor for increased absorption.
C. Review the medication regimen because cimetidine can interact with warfarin and phenytoin and should be separated from antacids.
D. Tell the client to stop taking warfarin while receiving cimetidine.
C. Cimetidine interactions with warfarin and phenytoin, and antacids should be separated from cimetidine. The nurse should review the medication schedule rather than stopping a prescribed medication independently.
A client with a history of peptic ulcer disease reports sudden severe abdominal pain. On assessment, the nurse notes a rigid, board-like abdomen and absent bowel sounds.
Which complication should the nurse suspect?
A. Gastric outlet obstruction
B. Peptic ulcer perforation
C. Acute cholecystitis
D. Hepatic encephalopathy
B. A rigid, board-like abdomen with sudden severe pain is highly concerning for perforation of a peptic ulcer, which can lead to peritonitis. This is a surgical emergency.
A client with diabetic gastroparesis is prescribed metoclopramide (Reglan). Which findings should the nurse instruct the client to report immediately?
Select all that apply.
A. Involuntary facial movements
B. Mild diarrhea after a dose
C. Muscle spasms of the neck
D. New restlessness or inability to remain still
E. Increased bowel sounds
F. Repetitive tongue movements
A client with a duodenal ulcer is prescribed sucralfate and several other medications. Which nursing action is most appropriate?
A. Administer sucralfate immediately after meals.
B. Administer sucralfate on an empty stomach and separate it from other medications as prescribed.
C. Mix sucralfate with an antacid to enhance its protective effect.
D. Administer sucralfate only when the client reports ulcer pain.
B. Sucralfate should be administered on an empty stomach, generally 1 hour before meals and at bedtime. It can also interfere with the absorption of other medications, so appropriate separation is important.
A client with chronic GERD reports worsening symptoms despite taking the prescribed medication. The nurse reviews the client's daily habits.
Which client statement indicates the greatest need for further teaching?
A. “I elevate the head of my bed when I sleep.”
B. “I eat smaller meals instead of large meals.”
C. “I have a cup of coffee and chocolate dessert every night before bed.”
D. “I avoid tight clothing around my abdomen.”
C: 🚨 Coffee + chocolate before bed can worsen GERD.
A client with ulcerative colitis is experiencing an acute exacerbation. Which finding should the nurse recognize as the highest priority?
A. Six episodes of bloody diarrhea accompanied by increasing weakness and dizziness
B. Abdominal cramping before bowel movements
C. Decreased appetite for 2 days
D. Mild fatigue after several loose stools
A. Frequent bloody diarrhea with weakness and dizziness raises concern for significant fluid loss, electrolyte imbalance, and possible GI bleeding. This takes priority over the other expected symptoms.
A nurse is caring for a client with advanced cirrhosis progressing toward liver failure. Which findings should the nurse anticipate?
Select all that apply.
A. Jaundice and pruritus
B. Increased platelet and white blood cell counts
C. Decreased clotting factors
D. Impaired glucose regulation
E. Splenomegaly with decreased blood-cell counts
F. Improved renal function as liver function declines
A client with advanced cirrhosis and portal hypertension suddenly vomits approximately 500 mL of bright-red blood. The client is pale, restless, and has a blood pressure of 82/48 mm Hg with a heart rate of 124/min.
Which action should the nurse take first?
A. Administer the prescribed lactulose.
B. Obtain a stool specimen for occult blood.
C. Place the client in a high-Fowler's position and offer oral fluids.
D. Activate emergency assistance and initiate measures to support airway and circulation
D. This client is showing signs of a massive upper GI hemorrhage, likely related to esophageal varices from portal hypertension. The severe hypotension and tachycardia indicate compromised circulation. The immediate priority is airway and circulatory support.
A client with cirrhosis is receiving lactulose for hepatic encephalopathy. Which finding best indicates that the treatment is achieving the desired therapeutic effect?
A. The client has two to three soft stools daily and demonstrates improved orientation.
B. The client develops increasing abdominal distention and constipation.
C. The client becomes increasingly drowsy and difficult to arouse.
D. The client's serum ammonia level continues to rise despite treatment.
A. Lactulose helps reduce ammonia absorption. Improved orientation and 2–3 soft stools per day indicate the medication is having its intended effect.
A client with peptic ulcer disease suddenly reports dizziness and weakness. The nurse observes coffee-ground emesis and a blood pressure of 90/56 mm Hg.
Which action should the nurse take first?
A. Administer the prescribed antacid.
B. Encourage the client to drink clear liquids.
C. Obtain a stool specimen for occult blood.
D. Assess airway and circulation and initiate emergency measures for possible hemorrhage.
D. Coffee-ground emesis, dizziness, weakness, and hypotension strongly suggest upper GI hemorrhage. The priority is airway and circulation, because significant bleeding can rapidly progress to hypovolemic shock.
A nurse is teaching a client about viral hepatitis based on the course material. Which statements are accurate?
Select all that apply.
A. Hepatitis C can become a chronic infection.
B. Hepatitis C has an available vaccine that provides lifelong immunity.
C. Chronic hepatitis B and C can contribute to cirrhosis and liver cancer.
D. Hepatitis A has a specific antiviral medication that cures the infection.
E. Hepatitis C can be treated with antiviral medications that may cure the infection.
F. Hepatitis B has a vaccine available for prevention.
A client with severe diarrhea is prescribed diphenoxylate/atropine (Lomotil). Which assessment finding should cause the nurse to question the prescription?
A. The client has frequent watery stools and mild abdominal cramping.
B. The client has a history of seasonal allergies.
C. The client has severe electrolyte imbalance and suspected pseudomembranous enterocolitis.
D. The client reports difficulty sleeping because of frequent diarrhea.
C. severe electrolyte imbalance and pseudomembranous enterocolitis as contraindications to diphenoxylate/atropine. Suppressing intestinal motility in these situations can worsen the underlying problem.
A client has been taking omeprazole (Prilosec) for an extended period. Which findings or interventions should the nurse associate with this medication?
Select all that apply.
A. Monitor for hypomagnesemia with prolonged therapy.
B. Encourage calcium and vitamin D intake as appropriate.
C. Instruct the client to take the medication approximately 1 hour before food.
D. Instruct the client to discontinue weight-bearing exercise while taking the medication.
E. Instruct the client to report severe or persistent diarrhea.
F. Explain that prolonged therapy may increase the risk of bone loss.
A client with a history of chronic pancreatitis reports worsening epigastric pain that radiates to the back. The client has nausea, vomiting, and several episodes of fatty stools. Which additional finding should the nurse recognize as a potential complication requiring close monitoring?
A. Increased appetite and weight gain
B. Elevated blood glucose level
C. Decreased abdominal discomfort after eating
D. Increased bowel sounds with formed stools
B. Chronic pancreatitis can progressively damage the pancreas, including its endocrine function. This can cause impaired insulin regulation and hyperglycemia/diabetes. Fatty stools and weight loss also reflect impaired exocrine function and malabsorption.
A nurse is teaching a client about psyllium (Metamucil) and polyethylene glycol (MiraLAX). Which statements are correct?
Select all that apply.
A. Psyllium should be taken with at least 8 oz of water.
B. Psyllium can decrease the absorption of some oral medications.
C. Polyethylene glycol works by drawing water into the intestines.
D. Both medications are appropriate for a client with a known bowel obstruction.
E. Polyethylene glycol can cause electrolyte imbalances with use.
F. Psyllium is preferred when the client has difficulty swallowing.
A client has been experiencing severe diarrhea for 24 hours. Which assessment finding requires the most immediate intervention?
A. Hyperactive bowel sounds
B. Two loose stools during the morning
C. Dry mucous membranes, tachycardia, and urine output of 15 mL/hr
D. Mild abdominal cramping before defecation
C. Dry mucous membranes, tachycardia, and urine output of only 15 mL/hr indicate significant fluid volume depletion from diarrhea. Fluid and electrolyte replacement is the priority.
A client with a chronic malabsorption disorder reports persistent diarrhea, steatorrhea, fatigue, muscle weakness, and unintentional weight loss. Which additional finding would the nurse anticipate?
A. Vitamin and mineral deficiencies
B. Increased bone density
C. Decreased risk for anemia
D. Increased absorption of vitamin B12 and iron
A. Malabsorption can prevent adequate absorption of nutrients, leading to vitamin and mineral deficiencies, anemia, fatigue, muscle weakness, weight loss, and problems involving the skin, hair, and bones.
A client is admitted with a small bowel obstruction. The client has abdominal distention, colicky abdominal pain, nausea, and repeated vomiting. An NG tube has been inserted for decompression.
Four hours later, which finding requires the nurse to notify the provider immediately?
A. NG tube has drained 850 mL of greenish fluid.
B. The client reports decreased nausea after NG decompression.
C. The client's abdomen becomes increasingly rigid and the pain changes from intermittent cramping to constant severe pain.
D. The client reports no bowel movement since admission.
C: 🚨 Constant severe pain + rigidity = possible perforation.
A nurse is assessing a client with cirrhosis and portal hypertension. Which findings should the nurse expect?
Select all that apply.
A. Esophageal varices
B. Splenomegaly
C. Ascites
D. Increased platelet count
E. Increased risk for GI hemorrhage
F. Improved clearance of ammonia
A client with suspected acute cholecystitis reports worsening right upper-quadrant pain. Which additional finding is most concerning and should prompt the nurse to notify the provider?
A. Mild nausea after eating
B. Pain radiating to the right scapula
C. Low-grade temperature of 100.4°F (38°C)
D. Increasing abdominal pain accompanied by a rising temperature and elevated WBC count
A client with chronic pancreatitis has persistent epigastric pain, diarrhea, weight loss, and fatty stools. Which nursing intervention is most appropriate based on the client's condition?
A. Encourage a low-calorie, low-protein diet.
B. Administer prescribed pancreatic enzymes and encourage a high-protein, high-calorie diet.
C. Restrict all oral intake indefinitely to decrease pancreatic stimulation.
D. Encourage increased alcohol intake with meals to improve digestion.
B. Chronic pancreatitis causes progressive pancreatic damage, which can lead to malabsorption and fatty stools. The PowerPoint identifies pancreatic enzymes and a high-protein, high-calorie diet as part of management.
A client with cirrhosis is being monitored for hepatic encephalopathy. Which assessment finding represents the most advanced neurologic deterioration?
A. Restlessness
B. Confusion
C. Difficulty concentrating
D. Coma
D. Hepatic encephalopathy can progress from restlessness and confusion to increasingly impaired consciousness, seizures, and ultimately coma. Coma represents the most advanced neurologic deterioration listed in your PowerPoint.