ATI LPN
Test Bank for Medical Surgical Nursing: Concepts for Interprofessional Collaborative Care 10th Edition
Chapter 52 : Assessment of the Gastrointestinal System Questions
Question 1 of 5
A client scheduled for a percutaneous transhepatic cholangiography (PTC) denies allergies to medication. What action by the nurse is best?
Correct Answer: A
Rationale: PTC uses iodinated dye, so the client should be asked about seafood allergies, specifically to shellfish, as these may indicate a risk for iodine allergy. Documentation should occur, but this is not the priority. The client will need a ride home afterward if the procedure is done as an outpatient, but this is not the priority action.
Question 2 of 5
A client is having an esophagealgrosodendonescoropy (EGD) and has been given midazolam hydrochloride (Vessel). The clients respiratory rate is 8 breaths/min. What action by the nurse is best?
Correct Answer: C
Rationale: For an EGD, clients are given mild sedation but should still be able to follow commands. For shallow or slow respirations after sedation is given, the nurse's first action is to provide physical stimulation such as a sternal rub and directions to breathe deeply. Naloxone is not the antidote for midazolam (Versed). The Rapid Response Team is not needed at this point. The client does not need manual ventilation.
Question 3 of 5
A client is scheduled for a colonoscopy and the nurse has provided instructions on the bowel cleansing regimen. What statement by the client indicates a need for further teaching?
Correct Answer: A
Rationale: The client should be advised to avoid beverages and gelatin that are red, orange, or purple in color as their residue can appear to be blood. The other statements show a good understanding of the preparation for the procedure.
Question 4 of 5
A client had a colossoscopy and biopsy yesterday and calls the gastrointestinal clinic to report a spot of bright red blood on the toilet paper today. What response by the nurse is best?
Correct Answer: B
Rationale: A small amount of bright red blood on the toilet paper after a colonoscopy with biopsy is not uncommon due to minor irritation or trauma from the procedure. The nurse should advise the client to monitor the bleeding and call back if it worsens, as this could indicate a more serious issue. Immediate clinic evaluation is not necessary for a small spot of blood. Stool softeners or activity restrictions are not directly relevant unless specified by the provider.
Question 5 of 5
A nurse is examining a client reporting right upper quadrant (RUQ) abdominal pain. What technique should the nurse use to assess this clients abdomen?
Correct Answer: C
Rationale: If pain is present in a certain area of the abdomen, that area should be palpated last to keep the client from tensing up, which could affect the rest of the examination. Auscultation of the abdomen occurs prior to palpation to avoid altering bowel sounds.