MS2 EXAM2 GASTRO HEPATOBILIARY PANCREATIC SYSTEMS

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MS2 EXAM2 GASTRO HEPATOBILIARY PANCREATIC SYSTEMS
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2012-11-25 14:46:41
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MS2 EXAM2 GASTRO HEPATOBILIARY PANCREATIC SYSTEMS
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  1. Which of the following structures are connected by the ileocecal valve?

    a.  Duodenum to the stomach
    b.  Colon to the small intestine
    c.  Stomach to the esophagus
    d.  Ileum to the jejunum
    • b. Colon to the small intestine
  2. Mechanical digestion in the stomach is accompanied by which of the following structures?

    a.  Mucosa
    b.  Smooth muscle layers
    c.  Striated muscle layers
    d.  Gastric glands
    b. Smooth muscle layers
  3. Gastric juice contributes to the digestion of which of the following types of nutrients?

    a.  Proteins
    b.  Fats
    c.  Starch
    a. Proteins

  4. The enzymes of the small intestine contribute to the digestion of which of the follwing types of nutrients?

    a.  Proteins
    b.  Fats
    c.  Disaccharides
    • c. Disaccharides
  5. Which of the following structures carries bile and pancreatic juices to the duodenum?

    a.  Pancreatic duct
    b.  Cystic duct
    c.  Hepatic duct
    d.  Common bile duct
    • d. Common bile duct
  6. Which of the following diagnostic procedures on stool specimens must the nurse collect using sterile technique?

    a.  Stool for ova and parasites
    b.  Stool for occult blood
    c.  Stool culture
    d.  Stool for lipids
    • c. Stool culture
    • *Stool cultures must be collected using sterile technique so as not to introduce any pathogens into the specimen that would alter the test results.
  7. Which of the following colors would the nurse recognize as an expected finding for the patient's stools immediately after a barium swallow?

    a.  Brown
    b.  Black
    c.  White
    d.  Green
    • c. White
    • *The chalky barium will cause the patient's stool to look white for 1 to 3 days after the procedure.
  8. Which of the following does the nurese understand is the primary reason a patient is NPO until the gag reflex returns after an EGD procedure?

    a.  To rest the vocal cords
    b.  To prevent aspiration
    c.  To keep the throat dry
    d.  To prevent vomiting
    • b. To prevent aspiration
    • *The gag reflex must return before the patient eats or drinks to prevent aspiration
  9. Which of the following positions would the nurse be correct in using for NG tube insertion?

    a.  Trendelenburg's
    b.  Prone
    c.  Sims'
    d.  High-fowler's
    • d. High-fowler's
    • *The pt sits upright to facilitate the tube moving down into the stomach by gravity.
  10. Bowel sounds heard as soft clicks and gurgles at a rate of 4 per min would be documented by the nurse as which of the following types of findings?

    a.  Absent
    b.  Hyperactive
    c.  Hypoactive
    d.  Normal
    • c. Hypoactive
    • Hypoactive bowel sounds occur less than 5 to 30 per minute. More than 30 would be hyperactive.
  11. Which of the following diagnostic procedures requires that a patient be NPO? (select all that apply)

    a.  Upper GI series (barium swallow)
    b.  Flat plate of the ABD
    c.  MRI
    d.  Esophagogastroduodenoscopy (EGD)
    e.  CT scan
    f.  Endoscopic retrograde cholangiopancreatography (ERCP)
    • a. Upper GI series (barium swallow)
    • c. MRI
    • d. Esophagogastroduodenoscopy (EGD)
    • e. CT scan
    • f. Endoscopic retrograde cholangiopancreatography (ERCP)
  12. Which of the following nursing diagnoses would be most appropriate to include in the POC following an upper GI series (barium swallow)? (select all that apply)

    a.  Risk for Constipation
    b.  Risk for Diarrhea
    c.  Risk for Pain
    d.  Imbalanced Nutrition:  More than body requirements
    e.  Deficient knowledge
    • a. Risk for Constipation
    • e. Deficient knowledge
  13. A patient has a duodenal peptic ulcer and is taking cimetidine (Tagamet). Which of the following side effects r/t cimetidine should be included in the teaching?

    a.  Confusion
    b.  Hypertension
    c.  Blurred vision
    d.  Dry mouth
    • a. Confusion
    • Confusion is a common side effect of cimetidine, especially in the elderly
  14. Which of the following surgical procedures is the most likely treatment for a pt w/gastric cancer?

    a.  Gastroplasty
    b.  Gastrorrhaphy
    c.  Gastric stapling
    d.  Gastrectomy
    • d. Gastrectomy
  15. Which of the following does the nurse understand is a sign or symptom of oral cancer?

    a.  Painless ulcer
    b.  White painful ulcers
    c.  Feeling of fullness
    d.  Heartburn
    a. Painless ulcer
  16. Which of the following procedures does the nurse understand is done paliatively for the dysphagia that occurs in inoperable esophageal cancer?
    • Esophageal dilation
    • Esophageal dilation is performed to enlarge the esophagus and allow food to pass the obstruction caused by the tumor.
  17. A patient is admitted with chronic gastritis type B. Which of the following S/S is the nurse likely to find on assessment?

    a.  Anorexia
    b.  Dysphagia
    c.  Diarrhea
    d.  Feeling of fullness
    a. Anorexia
  18. An asymptomatic pt is admitted with gastric bleeding. For which of the following S/S of severe gastric bleeding should the nurse monitor? (select all that apply)

    a.  Hypertension
    b.  Diaphoresis
    c.  Bounding pulse
    d.  Edema
    e.  Hypotension
    f.  Confusion
    • b. Diaphoresis
    • e. Hypotension
    • f. Confusion
    • Diaphoresis and hypotension are common signs of hypovolemic shock. Altered LOC or confusion is an indication of altered oxygenation, which accompanies shock.
  19. A pt had a gastrectomy 2 mo ago. The pt comes to the clinic for TX for greasy stools and frequent bowel movements. After the pt's surgical recovery and current eating habits are assessed, which of the following types of diet would be most appropriate for the nurse to teach the patient to use?

    a.  Bland diet
    b.  High-carbohydrate diet
    c.  Low-fat diet
    d.  Pureed diet
    c. Low-fat diet
  20. A pt visits her gynecologist and reports that she is very unhappy with her weight of 310 lb on her 5'7" frame. When planning her care, the nurse knows that the initial tx for obesity includes which of the following?

    a.  Gastroplasty
    b.  Billroth I procedure
    c.  Billroth II procedure
    d.  Diet management
    • d. Diet management
  21. A pt has been diagnosed w/a hiatal hernia. The pt has heartburn and occasional regurgitation. Which of the following interventions should the nurse teach the pt to reduce the symptoms?

    a.  Eat small, frequent meals
    b.  Recline for 1hr after meals
    c.  Sleep flat w/out a pillow
    d.  Eat a bedtime snack
    • a. Eat small, frequent meals
  22. A pt is having an acute episode of gastric bleeding.  The physician orders an IV of 1000 mL of 0.9% normal saline, a CBC, an NG tube to low-wall suction, and O2 by nasal cannula. Which of the following orders should the nurse perform first?

    a.  Administer the IV of 1000 mL of 0.9% normal saline
    b.  Draw the blood for the CBC
    c.  Insert the NG tube
    d.  Apply O2 by nasal cannula
    • d. Apply O2 by nasal cannula
  23. A patient is taught preventive measure for gastroesophageal reflux disease (GERD).  Which of the following patient statements indicates that teaching has been effective?

    a.  I need to eat large meals
    b.  I will sleep without pillows
    c.  I need to lie down for 2hrs after each meal
    d.  I will identify foods that cause discomfort.
    d. I will identify foods that cause discomfort.
  24. The nurse is caring for a pt who recently returned from surgery after fundoplication. Which of the following symptoms is essential to report to the physician?

    a.  Nausea
    b.  Pain rated as 4 out of 10
    c.  Dysphagia
    d.  Thirst
    c. Dysphagia
  25. What differentiates diverticulitis from diverticulosis? (select all that apply)

    a.  Presence of weakness in bowel wall
    b.  Presence of outpouchings on bowel mucous membrane
    c.  Presence of inflammation and infection
    d.  Lack of symptoms
    • c. Presence of inflammation and infection
    • d. Lack of symptoms
    • Both have outpouchings, but diverticulosis is asymptomatic, and diverticulitis involves infection and inflammation.
  26. A pattern of alternating constipation and diarrhea is most characteristic of which of the following GI tract disorders?

    a.  Crohn's disease
    b.  Ulcerative colitis
    c.  Irritable bowel syndrome (IBS)
    d.  Large bowel obstruction
    • c. Irritable bowel syndrome (IBS)
    • IBS is a disorder of altered intestinal mobility in which disorderly contractions of the colon lead to a pattern of alternating diarrhea and constipation.  It is a functional problem, not a disease.
  27. Which of the following drugs would the nurse expect to be prescribed for a woman with IBS and constipation?

    a.  Amitriptyline (Elavil)
    b.  Dicyclomine (Bentyl)
    c.  Paroxetine HCI (Paxil)
    d.  Hyoscyamine (Levbid)
    • c. Paroxetine HCI (Paxil)
    • For some women with IBS and constipation, paroxetine HCI (Paxil) is used as antidepressants block the brain's perception of ABD pain.  The other 3 drugs listed are used to treat IBS with diarrhea.
  28. A pt who has ulcerative colitis is taken to the ER w/severe rectal bleeding. Which of the following is the best option for maintaining nutritional status for this pt w/ulcerative colitis who must be NPO for an extended period of time?

    a.  NG tube feedings
    b.  PEG tube feedings
    c.  Total parenteral nutrition (TPN)
    d.  IV 5% dextrose and water
    • c. Total parenteral nutrition (TPN)
    • TPN is the only way to adequately feed a person for an extended period w/out using the gut.
  29. A patient is diagnosed w/acute diverticulitis.  Which of the following may have placed the pt at risk for developing diverticulitis?

    a.  Eating a low-fiber diet
    b.  Chronic diarrhea
    c.  History of NSAID use
    d.  Family history of colon cancer
    a. Eating a low-fiber diet
  30. Which of the following foods might a pt with diverticulitis be instructed to avoid?

    a.  Peanuts and raspberries
    b.  Apples and pears
    c.  Red meat and dairy products
    d.  Bran and whole grains
    a. Peanuts and raspberries
  31. Which of the following nursing diagnoses is most appropriate to include in the POC for a pt w/symptoms of a bowel obstruction?

    a.  Risk for Impaired Swallowing r/t NPO status
    b.  Risk for Urinary Retention r/t fluid vol depletion
    c.  Risk for Deficient Fluid Vol r/t nausea and vomiting
    d.  Risk for Ineffective Coping r/t prolonged hospitalization
    c. Risk for Deficient Fluid Vol r/t nausea and vomiting
  32. Which of the following explanations by the nurse to reinforce the pt's preop education for a loop ostomy would be correct?

    a.  You will have a stoma in the middle of your ABD that will constantly drain liquid stool
    b.  You will have a looped bag system to collect stool from your stoma
    c.  You will have a loop of bowel on your ABD, but it will not drain stool
    d.  You will have a loop of bowel on your ABD that can be put back in after your bowel has healed.
    d. You will have a loop of bowel on your ABD that can be put back in after your bowel has healed.
  33. Which of the following dietary instructions is most important to include in the POC to prevent complications for a pt w/an ileostomy?

    a.  Drink lots of fluids to prevent dehydration
    b.  Avoid fruits and vegetables to prevent diarrhea
    c.  Avoid milk products to prevent gas
    d.  Eat plenty of fiber to prevent constipation
    a. Drink lots of fluids to prevent dehydration
  34. A patient is concerned about ileostomy odor. Which of the following responses by the nurse would be best?

    a.  A tsp of baking soda in your pouch will absorb all the odor
    b.  The plastic your pouch is made of is odor-proof. You shouldn't have to worry about odor as long as you don't have a leak
    c.  Effluent from an ileostomy has no odor. It is colostomies that can smell bad drom time to time
    d.  Changing your pouch and face plate daily will help prevent odor
    b. The plastic your pouch is made of is odor-proof. You shouldn't have to worry about odor as long as you don't have a leak
  35. The nurse is counseling a pt w/frequent anal fissures and a hx of constipation. Which of the following indicates that teaching has been effective?
    It is important that I not ignore the urge to have a bowel movement
  36. Which of the following precautions will protect the nurse who is caring for the patient w/hepatitis B?

    a.  Reverse isolation
    b.  Standard precautions
    c.  Respiratory precautions
    d.  Enteric precautions
    b. Standard precautions
  37. Acute liver failure is most often caused by which of the following?

    a.  Antibiotic use
    b.  Daily vitamins
    c.  Alcohol use
    d.  Acetaminophen (Tylenol) overdose
    d. Acetaminophen (Tylenol) overdose
  38. Which of the following is a treatment for bleeding esophageal varices?  (select all that apply)

    a.  variceal ligation (banding)
    b.  octreotide (Sandostatin) IV
    c.  soft diet
    d.  sclerotherapy
    • a. variceal ligation (banding)
    • b. octreotide (Sandostatin) IV
    • d. sclerotherapy
    • Banding of varices w/rubber bands during endoscopy stops bleeding. The synthetic hormone octreotide (Sandostatin) IV may vasoconstrict; injection of a sclerosing agent causes thickening and closing of dilated vessels. Soft diet N/A - pt would be NPO
  39. Which of the following is a nonsurgical intervention for the management of biliary colic?
    Administering propantheline (Pro-Banthine)
  40. Patients w/a history of pancreatic disease commonly have a history of which of the following?

    a.  High-protein diet
    b.  Very-low fat diet
    c.  Excessive alcohol consumption
    d.  Excessive intake of vitamin C
    c. Excessive alcohol consumption
  41. Patients with acute pancreatitis frequently describe their pain as which of the following?
    a. Dull, boring, beginning in the mid epigastrium and radiating to the back
  42. A patient with ascites is placed on a low-sodium diet. The nurse knows that diet teaching has been successful if the pt selects which of the following meals?
    Baked chicken, white rice, and apple juice
  43. What are the factors of gallbladder disease?
    • Obesity
    • Multiple pregnancies
    • Age 40 or older
    • Fasting
    • Diabetes mellitus
    • *Females are more at risk
  44. Which of the following instructions should be given to the pt w/portal hypertension? (select all that apply)

    a.  Cough and deep breathe every 2 hrs
    b.  Avoid straining to have a bowel movement
    c.  Avoid heavy lifting
    d.  Increase fluid intake
    e.  Take vitamin K supplements
    f.  Expect urine to be tea colored
    • b. Avoid straining to have a bowel movement
    • c. Avoid heavy lifting
  45. A patient with cirrhosis has asterixis and fector hepaticus and is confused. The nurse recognizes  these as symptoms of which complication?
    Hepatic encephalopathy

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